Osmotic Demyelination Syndrome after Correction of Hyponatremia: A Case Report.

Abstract

A 45-year-old man with a history of a cerebrovascular accident (without residual deficits), hypertension, and hyperlipidemia presented to an outside hospital with 1 day of dizziness, fatigue, nausea, and vomiting while on a business trip. Nausea with vomiting and diarrhea had begun after eating at a buffet 3 days prior to his presentation. He stated that he had been drinking a “ton” of water since vomiting had begun. Medications included hydrochlorothiazide, aspirin, amlodipine, and benazepril. He denied use of alcohol or illicit drugs. Physical examination was unremarkable. His blood pressure was 98/48 mmHg, heart rate was 86/min, and respiratory rate was 18/min. He was afebrile. Admission laboratory values (reference intervals) were [Na+], 101 mmol/L (135–145 mmol/l); [K+], 2.2 mmol/L (3.5–4.5 mmol/L); [Cl−], <65 mmol/l (98–107 mmol/L); [HCO3−], 45 mmol/L (23–29 mmol/L); and glucose, 104 mg/dL (60–99 mg/dL). He was admitted to the outside hospital, where infusion of 3% normal saline with supplemental KCl was initiated. Over the next 24 h, his [Na+] increased to 129 mmol/L. The patient was discharged with an [Na+] of 130 mmol/L; he was encouraged to follow-up for a possible early movement disorder as he had developed upper extremity tremor and confusion during his admission. …