Osmotic Demyelination Syndrome Complicating Moderate Hyponatremia Correction in the Emergency Department: A Case...

Osmotic demyelination syndrome (ODS) is a rare neurological complication that can be associated with rapid correction of hyponatremia. This report describes a middle-aged male patient with a chronic alcoholism history who developed ODS following moderate hyponatremia correction with 1.5 L of isotonic saline in the emergency department. Initially, the patient presented with tremors and ataxia, which later progressed to lower limb weakness and slurred speech. An initial MRI of the brain showed pontine diffusion restriction, which was misinterpreted as acute ischemic stroke. However, follow-up imaging confirmed central pontine lesions, consistent with ODS. Despite physiotherapy, the patient developed complications, including subdural hematoma, and succumbed to cardiac arrest. This case highlights the risk of ODS even with moderate hyponatremia and underscores the need for cautious sodium correction, close monitoring, and thorough evaluation to prevent misdiagnosis and associated adverse outcomes. It emphasizes the importance of vigilance in managing high-risk patients to avoid this potentially fatal condition.