Osmosis-induced Central Pontine Myelinolysis

Abstract

Background: Central pontine demyelinating disease (CPD) is a disease selectively caused by an acute increase in serum osmotic concentration. The main causes of this disorder include chronic malnutrition, chronic dialysis, excessive use of diuretics, acute correction of chronic hyponatremia, and chronic alcohol consumption. However, hypernatremia-induced CPD is rare and has a high mortality rate. We report a case of a 50-year-old woman with chronic alcoholism who presented with severe hypernatremia and severe neurological deficits. On arrival to the hospital, he was diagnosed with severe hypernatremia (165.8 mmol/L), hyperosmotic pressure (349 mOsm/L) and changes in magnetic resonance imaging (MRI). In the treatment, 0.45% saline solution was gradually continued until the sodium level in the plasma was normalized, and the physical condition and clinical course gradually improved. Conclusions: If a marked change in serum sodium level is detected, normalization of sodium should be avoided because of the risk of brain edema. Also, in the case of obvious changes in plasma sodium level (hyponatremia and hypernatremia) without clinical symptoms, but with risk factors, early detection by CRT of the brain is important to prevent the development of TTTME, and thus the patient’s life and work disability.