Osmotic demyelination syndrome: a potentially avoidable disaster

Osmotic demyelination of the brain (ODS) is a dreaded complication that typically occurs several days after aggressive therapy for chronic hyponatraemia, but is eminently avoidable. In this teaching exercise, Professor McCance, an imaginary consultant, is asked to explain how he would have treated a...

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Bibliographic Details
Published in:QJM : An International Journal of Medicine 2003-12, Vol.96 (12), p.935-947
Main Authors: Lin, S.-H., Hsu, Y.-J., Chiu, J.-S., Chu, S.-J., Davids, M.R., Halperin, M.L.
Format: Article
Language:English
Subjects:
Addison Disease - complications
Adult
Biological and medical sciences
Brain Diseases - prevention & control
Demyelinating Diseases - prevention & control
Female
General aspects
Humans
Hyperkalemia - drug therapy
Hypoglycemia - drug therapy
Hyponatremia - drug therapy
Hypotension - drug therapy
Medical sciences
Renal Agents - administration & dosage
Syndrome
Vasopressins - administration & dosage
Water-Electrolyte Imbalance - prevention & control
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Summary:Osmotic demyelination of the brain (ODS) is a dreaded complication that typically occurs several days after aggressive therapy for chronic hyponatraemia, but is eminently avoidable. In this teaching exercise, Professor McCance, an imaginary consultant, is asked to explain how he would have treated a 28-year-old female who had hyperkalaemia, hypoglycaemia, hypotension and hyponatraemia (118 mM) to prevent the development of ODS. He begins with a review of the physiology, including his own landmark work on chronic hyponatraemia associated with a contracted extracellular fluid volume. Adding quantitative analysis, the cause of the excessive rise in plasma sodium concentration is revealed, and a better plan for therapy is proposed.
ISSN:1460-2725
1460-2393
DOI:10.1093/qjmed/hcg159