Abstract Details

Title Managing Rapid Sodium Correction: A Case of Osmotic Demyelination

Topic General Neurology

Presentation(s) P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 187

Objective N/A

Background Severe alcoholism may predispose to chronic hyponatremia. Osmotic Demyelination Syndrome (ODS) is associated with rapid correction of severe hyponatremia (<120 meq/L) by greater than 16 mEq in 48 hours. 33-55% of patients have a fatal outcome or permanent disability. Though the best treatment is prevention, there is evidence that early detection through clinical course and diffusion-weighted imaging and early re-lowering of sodium could improve outcomes.

Design/Methods N/A

Results A 49-year-old African American male, chronic alcoholic, was found down with pulseless electric activity, resuscitated, and intubated. He had been receiving dextrose 5% normal saline when his sodium was found to be 119 with a glucose of 30. Given concern for cerebral edema, he was given hypertonic saline. Over 48 hours, his sodium was corrected from 119 to 139 and later to 145. 9 days later, he was extubated and noted to have significant bulbar and extraocular muscle weakness, symmetric flaccid bilateral upper and lower limb weakness with hyporeflexia, but largely preserved mental status. MRI brain showed evolution of changes in the pons concerning for ODS, "the trident sign". Interestingly, some early signs of upper motor neuron dysfunction began to evolve over the 2^nd week. Sodium was carefully re-lowered to 135 over next few days with major improvement in patient outcome. Over the entire course of admission, the patient demonstrated a rapid progression through paralysis and hypotonicity, to paralysis and hyperreflexia with hypertonicity, and eventually, a markedly improved neurological exam.

Conclusions

Chronic alcoholics may have a chronically low sodium at baseline. Rapid correction of sodium in a short time span may predispose to ODS. It is important to identify it promptly as careful and timely re-lowering of sodium earlier in the course helps towards a favorable outcome.

Authors/Disclosures
Sara Hubacek, MD PRESENTER	Dr. Hubacek has nothing to disclose.
Nelson Douglass, MD (University of Utah Medical Center)	Dr. Douglass has received personal compensation for serving as an employee of NowYouKnowNeuro.
Saurabh G. Shukla, MD (Lone Star Neurology)	Dr. Shukla has nothing to disclose.

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