Osmotic demyelination syndrome: a potentially avoidable disaster

• 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
• ISSN: 1460-2725; 1460-2393
• DOI: 10.1093/qjmed/hcg159

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.