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KMID : 0359920060250061035
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Korean Journal of Nephrology
2006 Volume.25 No. 6 p.1035 ~ p.1039
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A Case of Osmotic Demyelination Syndrome after Hemodialysis Treatment in a Uremic Patient with Severe Hyperosmolality
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Kang Hyeon-Hui
Song Joo-Yong
Yoon Na-Ri
Kang Kwi-Young
Kim Eun-Sook
Kim Young-Soo
Yoon Sun-Ae
Kim Young-Joo
Kim Young-Ok
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Abstract
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Osmotic demyelination syndrome (ODS) is a distinctive clinical syndrome with characteristic MR features in the central pons (central pontine myeli- nolysis) and in other brain locations (extrapontine myelinolysis). Rapid correction of hyponatremia is associated with ODS, but hyperosmolality rarely causes it. Here we report a case of ODS developed in a hemodialysis patient with severe uremia and concomitant hyperosmolality. A 67-year-old male was presented with general weakness and dyspnea. Laboratory findings showed severe uremia (blood urea nitrogen, 167 mg/dL; serum creatinine, 15 mg/ dL), hyperosmolality (336 mOsm/kg H2O), and normal range of sodium (145 mEq/L). After the first hemodialysis treatment, his consciousness was changed to lethargic state. We initially suspected dialysis disequilibrium syndrome, but the symptoms were aggravated. MRI showed edema in central pons and symmetrical extrapotine lesions in the subcortical white matter, lateral thalamus, and posterior capsule, consistent with ODS. In spite of aggressive measures including continuous renal replacement therapy, he died of sepsis at the 26th hospital day. (Korean J Nephrol 2006;25(6):1035-1039)
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KEYWORD
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Osmotic demyelination syndrome, Uremia, Hemodialysis
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