Osmotic demyelination syndrome: novel risk factors and proposed pathophysiology

Ambati, Ravi; Kho, Lay Kun; Prentice, David; Thompson, Andrew

doi:10.1111/imj.15855

Cited by 12 publications

(8 citation statements)

References 37 publications

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“…In over 75% of cases, ODS occurs after rapid correction of hyponatremia, and the mechanism is thought to be related to a relatively hypertonic insult [1,6]. Alcoholism, cirrhosis, malnutrition, and severe burns are some of the other conditions often accompanied by hyponatremia and have been described as risk factors for triggering ODS [1,7]. Our patient's history of alcoholism and HCV could have impacted her susceptibility.…”

Section: Discussionmentioning

confidence: 87%

Osmotic Demyelination After Rapid Correction of Hyperosmolar Hyperglycemia

Jain¹,

Kotwal²,

Gnanaraj³

et al. 2023

Cureus

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Osmotic demyelination syndrome (ODS) is seen due to an overt rise in serum osmolality, most often during rapid correction of chronic hyponatremia. We present the case of a 52-year-old patient who presented with polydipsia, polyuria, and elevated blood glucose with rapid correction of glucose levels under five hours and developed dysarthria, left-sided neglect, and unresponsiveness to light touch and pain in the left extremities on the second day of hospitalization. MRI revealed restricted diffusion in the central pons, extending into extrapontine areas suggestive of ODS. Our case highlights the importance of cautious correction of serum hyperglycemia and monitoring serum sodium levels in patients with a hyperosmolar hyperglycemic state (HHS).

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Section: Discussionmentioning

confidence: 87%

Osmotic Demyelination After Rapid Correction of Hyperosmolar Hyperglycemia

Jain¹,

Kotwal²,

Gnanaraj³

et al. 2023

Cureus

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“…This condition is infrequently described and is associated with the presence of risk factors for this disease, for example, as alcohol use disorder and dysnatremia-causing pathology such as diabetes insipidus. Irregular treatment adherence was a relevant factor in this patient 2 13 14…”

Section: Discussionmentioning

confidence: 93%

Severe osmotic demyelination syndrome with cortical involvement in the context of severe hyponatremia and central diabetes insipidus: an uncommon presentation of an unusual combination

Giglio,

Reccius,

Ferre

et al. 2024

BMJ Case Rep

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Background: Osmotic demyelination syndrome (ODS) with cerebral cortical involvement is a rare complication of severe hyponatremia correction. Careful management of hyponatremia is crucial, particularly in patients with risk factors, such as alcohol use disorder and diabetes insipidus.Case: A patient in his 40s with a history of alcohol use disorder and central diabetes insipidus developed ODS after a 24 mEq/L osmolar increase during the treatment of hyponatremia. The patient’s condition progressed into locked-in syndrome and then improved to spastic tetraparesis after cortical basal ganglia ODS improved.Discussion: The differential diagnosis of cortical demyelination includes laminar cortical necrosis, being the interpretation of Apparent Diffusion Coefficient (ADC) MRI sequence is a useful tool.This case underscores the need to investigate and improve diagnosis and treatment strategies in patients with ODS. It also emphasises the significance of careful hyponatremia correction and frequent monitoring, particularly in patients with known risk factors for ODS.

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“…Animal studies and case reports in humans have demonstrated that overcorrection of severe (<115 mEq/L) and chronic hyponatremia (>48 h) by >25 mEq/L can produce brain injury from cerebral demyelination [ 16 , 17 ]. There are numerous risk factors for developing demyelination, independent of the rate of correction, including severe liver disease, alcoholism, hypokalemia, hypophosphatemia, hypoxia, and malnutrition [ 18 ]. When demyelination occurs in high-risk patients, it can be difficult to ascertain what role the correction of hyponatremia played.…”

Section: Discussionmentioning

confidence: 99%

Administration of 3% Sodium Chloride and Local Infusion Reactions

2022

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Three-percent sodium chloride (3% NaCl) is a hyperosmolar agent used to treat hyponatremic encephalopathy or other cases of increased intracranial pressure. A barrier to the use of 3% NaCl is the perceived risk of local infusion reactions when administered through a peripheral vein. We sought to evaluate reports of local infusion reactions associated with 3% NaCl over a 10-year period throughout a large healthcare system. A query was conducted through the Risk Master database to determine if there were any local infusion reactions associated with peripheral 3% NaCl administration throughout the entire UPMC health system, which consists of 40 hospitals with 8400 licensed beds, over a 10-year time period from 14 May 2010 to 14 May 2020. Search terms included infiltrations, extravasations, phlebitis, IV site issues, and IV solutions. There were 23,714 non-chemotherapeutic and non-contrast-associated intravenous events, of which 4678 (19.7%) were at UPMC Children’s Hospital. A total of 2306 patients received 3% NaCl, of whom 836 (35.8%) were at UPMC Children’s Hospital. There were no reported local infusion reactions with 3% NaCl. There were no reported local infusion reaction events associated with 3% NaCl in a large healthcare system over a 10-year period. This suggests that 3% NaCl can be safely administered through a peripheral IV or central venous catheter.

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Osmotic demyelination syndrome: novel risk factors and proposed pathophysiology

Cited by 12 publications

References 37 publications

Osmotic Demyelination After Rapid Correction of Hyperosmolar Hyperglycemia

Osmotic Demyelination After Rapid Correction of Hyperosmolar Hyperglycemia

Severe osmotic demyelination syndrome with cortical involvement in the context of severe hyponatremia and central diabetes insipidus: an uncommon presentation of an unusual combination

Administration of 3% Sodium Chloride and Local Infusion Reactions

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