Open AccessTherapeutic challenges in the management of osmotic demyelination syndrome
Author(s) -
Mohamed Elshafei,
Mohammed Danjuma,
Rania El Tahir
Publication year - 2020
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000020283
Subject(s) - medicine , hyponatremia , lethargy , concomitant , desmopressin , emergency department , anesthesia , intensive care medicine , psychiatry
Rationale: There is an increasing and compelling need for early recognition of features of osmotic demyelination syndrome (ODS), and a further attempt at correcting this even where presentation is late. Patient concerns: A 49-year-old male admitted into the emergency department with a complaint of lethargy and severe hyponatremia, with subsequent ODS supervening on initial attempts at correction. Diagnosis: Rapid rise in serum sodium concentration (121 mmol/L in 8 hours from a nadir of 101 mmol/L), concomitant deterioration in patient's conscious level support the diagnosis of ODS. Intervention: Concomitant administration of 5% dextrose water with desmopressin with a therapeutic objective of gradual relowering of serum sodium concentration. Outcomes: Significant improvement in patients’ conscious level and motor function with the commencement of sodium relowering therapy. The patient was eventually discharged home. Lessons: Regardless of the temporal profile of neurologic sequelae following ODS due to hyponatremia, its worthwhile attempting initial sodium relowering with dextrose 5% and desmopressin and then monitoring of biochemical and neurologic markers.