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Hypernatraemia and fatal osmotic demyelination syndrome: case report A 54-year-old man developed hypernatraemia and fatal osmotic demyelination syndrome during treatment with sodium chloride for hyponatraemia. The man, who had a history of alcohol dependence and alcoholic cardiomyopathy, presented with generalised weakness. He exhibited serum sodium levels of 101 mmol/L, alcoholic ketoacidosis and moderate hyperkalaemia. He was treated with desmopressin [DDAVP] and sodium chloride [saline] 3% [route and dosage not stated]. The sodium levels gradually increased to 132 mmol/L over the period of 8 days at a rate of 3–4 mmol/L/day. Eventually, the therapy was liberalised. He was transferred out of the ICU. On hospitalisation day 12, he was returned to the ICU with increased oxygen requirement. He was mildly hypernatraemic with sodium levels of 146 mmol/L. The sodium levels further increased to 155 mmol/L over following 2 days [duration of treatment to reaction onset not stated]. The man’s hypernatraemia was corrected to 144 mmol/L over following 48 hours. On hospitalisation day 20, he showed acute decline in the mental status with clonus, recurrent fevers and up-going plantar reflexes. Head CT scan and infectious work-up were unrevealing. Serial neurologic examinations performed over the following week demonstrated no improvement with only minimal facial and eye movements. MRI showed acute demyelination of bilateral thalami and pons compatible with osmotic demyelination syndrome. His family opted for comfort care, and he died in the ICU. He developed osmotic demyelination syndrome even after very slow correction of hyponatraemia complicated by hypernatraemia, the relevance of which was unclear. Bragg A, et al. A case of osmotic demyelination syndrome following gradual correction of hyponatremia. American Journal of Respiratory and Critical Care Medicine 199: (plus poster) abstr. A1726, No. 9, May 2019. Available from: URL: http://doi.org/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A1726 [abstract] 803447301

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Reactions 18 Jan 2020 No. 1787