Central pontine myelinolysis following ‘optimal’ rate of correction of hyponatraemia with a good clinical outcome

Ann Clin Biochem 2007;44:488-490
doi:10.1258/000456307781646067
© 2007 Association for Clinical Biochemistry

 

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Case Reports


V Georgy,
D Mullhi and
A F Jones


Department of Anaesthetics, Heart of England Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK;
Department of Anaesthetics, Heart of England Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK;
Department of Medicine, Heart of England Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK; Department of Clinical Biochemistry, Heart of England Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK

Central pontine myelinolyis (CPM), an acute demyelinating conditionof the brain stem, is a recognized complication of the treatmentof patients with chronic hyponatraemia (hyponatraemia >48h), particularly in those who abuse alcohol. The risk of CPMis believed to be associated with a rapid (>8 mmol/L/day)correction of the serum sodium concentration, which is saidto lead to an osmotically-induced demyelination. CPM is alsocommonly believed to have a poor, and often fatal, outcome.We report the case of a 37-year-old female alcoholic patientwho presented following a collapse, and who was hyponatraemic(serum sodium concentration 105 mmol/L). The rate at which theserum sodium concentration was corrected to normal was lessthan the 8 mmol/L/day guideline, but nonetheless she developedthe clinical and radiological features of CPM. She made a goodneurological recovery, however, and was able to be dischargedfrom hospital. CPM does not necessarily have a bleak prognosis,and may occur even with optimal rates of correction of the serumsodium concentration. Clinicians should recognize that the outcomeof CPM is not inevitably poor, and the complication may occurdespite appropriate management. It is possible that CPM is acomplication of the hyponatraemia itself, rather than the treatmentof the biochemical disturbance.


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