Central pontine myelinolysis: not just a low sodium issue

  • Gideon Titus Stellenbosch University
  • Luthando Vazi Stellenbosch University
  • Tholakele Sabela Stellenbosch University
  • Mogamat-Yazied Chothia Stellenbosch University and Tygerberg Hospital

Abstract

Osmotic demyelination syndrome is a rare complication following treatment of chronic hyponatraemia. We describe a case of a middle-aged man known with hypertension and hypothyroidism who presented with a reduced level of consciousness and a generalised convulsion. Laboratory results revealed severe hyponatraemia and hypokalaemia. Following rapid overcorrection of the serum sodium concentration, his level of consciousness remained unchanged, and he developed quadriplegia. Magnetic resonance imaging of the brain revealed central pontine myelinolysis (CPM). The patient died 3 weeks after hospitalisation. Other than rapid overcorrection of chronic hyponatraemia, this case also highlights the important role of potassium in the pathogenesis of CPM. Therefore, when severe chronic hyponatraemia is accompanied by hypokalaemia, the latter should be corrected first to further reduce the risk of CPM.

Author Biographies

Gideon Titus, Stellenbosch University
Department of Medicine, Registrar
Luthando Vazi, Stellenbosch University
Department of Medicine, Registrar
Tholakele Sabela, Stellenbosch University
Department of Medicine, Registrar
Mogamat-Yazied Chothia, Stellenbosch University and Tygerberg Hospital
Division of Nephrology, Stellenbosch University, Consultant
Published
2020-11-16
Section
Case Reports