Electrolytes & Blood Pressure  2015;13(1):30-36

doi:10.5049/EBP.2015.13.1.30

A Case of Osmotic Demyelination Presenting with Severe Hypernatremia.

Min Jee HAN 1 ; Do Hyoung KIM ; Young Hwa KIM ; In Mo YANG ; Joon Hyung PARK ; Moon Ki HONG

Affiliations

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Keywords

Hypernatremia; Osmotic demyelination syndrome; Magnetic resonance imaging

Country

Republic of Korea

Language

English

Abstract

Osmotic demyelination syndrome is a demyelinating disorder associated with rapid correction of hyponatremia. But, it rarely occurs in acute hypernatremia, and it leads to permanent neurologic symptoms and is associated with high mortality. A 44-year-old woman treated with alternative medicine was admitted with a history of drowsy mental status. Severe hypernatremia (197mEq/L) with hyperosmolality (415mOsm/kgH2O) was evident initially and magnetic resonance imaging revealed a high signal intensity lesion in the pons, consistent with central pontine myelinolysis. She was treated with 0.45% saline and 5% dextrose water and intravenous corticosteroids. Serum sodium normalized and her clinical course gradually improved. Brain lesion of myelinolysis also improved in a follow-up imaging study. This is the first report of a successful treatment of hypernatremia caused by iatrogenic salt intake, and it confirms the importance of adequate fluid supplementation in severe hypernatremia.