HYPONATREMIA-CENTRAL PONTINE MYELINOLYSIS

SUMMARY

1. Now called osmotic demyelination syndrome.

2. If the sodium concentration is raised too rapidly, the cells can shrink rapidly causing demyelination syndrome.

3. This rare effect is more likely to occur in the patient with chronic, severe hyponatremia (Na⁺ < 115 mEq/L for > 2 days) whose sodium is corrected rapidly (> 10 mEq/L over 24 hours).

4. Symptoms are delayed by about a week, compared to the rise in the sodium concentration, and are usually not reversible.

5. Presentation includes speech and swallowing difficulties, weakness or paralysis, cognitive deficits, seizures and coma.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].