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KMID : 1128320150130010030
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Electrolytes & Blood Pressure
2015 Volume.13 No. 1 p.30 ~ p.34
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A Case of Osmotic Demyelination Presenting with Severe Hypernatremia
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Han Min-Jee
Kim Do-Hyoung
Kim Young-Hwa
Yang In-Mo
Park Joon-hyung
Hong Moon-Ki
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Abstract
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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.
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KEYWORD
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Hypernatremia, Osmotic demyelination syndrome, Magnetic resonance imaging
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