Neuro

Cerebral Demyelination Syndrome

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Cerebral Demyelination Syndrome, Central Pontine Myelinolysis, Osmotic Demyelination Syndrome

  • See Also
  1. Hyponatremia
  2. Hyponatremia Management
  • Pathophysiology
  1. Lethal Cerebral edema from rapid Electrolyte correction
    1. Over-correction of Serum Sodium when <125 mEq/L
    2. Too rapid correction of Serum Sodium (>0.5 mEq/hour)
  2. Related to chronicity of Electrolyte disturbance
    1. Associated with rapid Sodium correction in chronic Hyponatremia (present >48 hours)
      1. Do not replace Serum Sodium more than 8 mEg/L per 24 hours
    2. Not associated with correction of acute Hyponatremia (esp. <24 hours)
      1. Severe symptomatic Hyponatremia (esp. <120 mEq/L) requires rapid Sodium replacement
  • Risk Factors
  1. Chronic Hyponatremia (present >48 hours)
  2. Serum Sodium <105 mEq/L
  3. Malnutrition
  4. Alcohol Use Disorder
  5. Hypokalemia
  • Prevention
  1. In chronic Hyponatremia, do not correct Sodium >0.5 mEq/h or >8 mEq/day
  2. Some recommend limiting daily maximum correction to 6 mEq/day
  3. Recognize overcorrection early and manage aggressively
    1. Stop Sodium replacement
    2. Reverse Sodium overcorrection
      1. Replace urinary water loss with free water orally (or D5W at 3 ml/kg/hour) OR
      2. Desmopressin 2 to 4 mcg IV every 8 hours
  • References
  1. Le and Drogell (2015) Crit Dec Emerg Med 29(11): 13-19
  2. Miller (2023) Am Fam Physician 108(5): 476-86 [PubMed]