Prolonged Altered Mental Status in a Diabetic Hemodialysis Patient

Area of Science:

• Neurology
• Endocrinology
• Nephrology

Background:

• Osmotic demyelination syndrome (ODS) is a neurological condition typically linked to rapid correction of hyponatremia.
• ODS is infrequently associated with hyperglycemia, making such cases noteworthy for understanding its pathophysiology.

Observation:

• A 28-year-old female with type 1 diabetes, hypertension, seizure disorder, and end-stage renal disease presented with unresponsiveness.
• The patient developed ODS following a hyperosmolar hyperglycemic state, despite having normal serum electrolyte levels.

Findings:

• This report details a rare instance of ODS occurring secondary to hyperosmolar hyperglycemic state.
• The case underscores that ODS can arise from osmotic shifts caused by severe hyperglycemia, not solely hyponatremia.

Implications:

• This case expands the known clinical spectrum of ODS triggers.
• Understanding ODS in the context of hyperglycemia is crucial for managing diabetic emergencies, especially in patients with comorbidities like renal disease.