Central pontine myelinolysis

Central pontine myelinolysis in a chronic alcoholic patient with mild hyponatremia: A case report

“…Since then, various guidelines have been proposed towards correction of sodium which has substantially improved patient morbidity and mortality [ 5 ]. It is a rare condition initially believed to affect the pons only, but recent literature suggests extrapontine involvement such as midbrain, thalamus, and cerebellum [ 6 ]. CPM is usually caused due to rapid correction of hyponatremia but rarely it can also occur in patients with hyperglycemia and hepatic failure [ 7 ].…”

Central Pontine Myelinolysis Complicating Hodgkin Lymphoma: A Case Report & Review of Literature

“…Since the original description of CPM by Adams & colleagues in 1959, several case series have been published associating it to the rapid sodium correction as its most important cause [1]. Rapid correction of the hyponatremia causes sudden rise in the tonicity in the interstitium surrounding the neuron which cannot be compensated at a rate commensurate with the production or regeneration of intracellular organic osmoles (such as myoinisotol, taurine, and glutamate); thereby leading to cell shrinkage and loss of oligodendrocytes & myelinolysis [3] Chronic alcoholism, malnutrition, liver disorders, rapid correction of the hyponatremia & use of chemotherapeutic agents known to cause hyponatremia are important risk factors for the development of CPM [4]. Chronic alcoholism, malnutrition, liver disorders predispose to the reduced synthesis and/or regeneration of these intracellular organic osmoles [4].…”

Korean Society of Nephrology 2022 Recommendations on controversial issues in diagnosis and management of hyponatremia

“…We analyzed the benefits of desmopressin with regard to overcorrection, ODS, and death. The risk of overcorrection is not equal among all patients, and there is an overcorrection risk group [11,[76][77][78][79]. Data on ODS or death occurring during the correction of hyponatremia are extremely rare, so large-scale clinical trials are necessary to evaluate benefits and risks.…”

“…High risk groups for overcorrection have been reported to include alcoholism, malnutrition, advanced liver disease, hypokalemia, and SNa of ≤105 mmol/L [11,[76][77][78][79]. In these groups, not only overcorrection but also safety indicators such as ODS and death are highly likely to occur, so it is necessary to prepare for this.…”