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Osmotic myelinolysis following chronic hyponatremia corrected at an overall rate consistent with current
Casey Dellabarca1, Karen S Servilla, Blaine Hart
1Medicine Service and Radiology Service, New Mexico Veterans Affairs Health Care System, University of New Mexico School of Medicine, Albuquerque, New Mexico 87108, USA.
Abstract:
Rapid correction of chronic hyponatremia (CH) may lead to the development of osmotic myelinolysis (OM), a condition with high mortality and high incidence of devastating neurological sequelae. Treatment guidelines suggest "safe" overall rates of correction of serum sodium concentration ([Na](s)) over the first 24 and 48 hours of treatment of CH. We report a patient with CH who developed fatal OM despite overall rates of correction of [Na](s) that were within the recommended rates. The potential risk factors for the development of OM in this patient included short (within a few hours) rises in [Na](s) exceeding 0.5 mmol/l per hour and the presence of severe protein malnutrition. We suggest that the rate of correction of [Na](s) in CH should be uniformly slow and that the overall rate of correction should be slower than the currently recommended rate in severely malnourished patients.
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