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Osmotic demyelination syndrome: a potentially avoidable disaster

2003; Oxford University Press; Volume: 96; Issue: 12 Linguagem: Inglês

10.1093/qjmed/hcg159

1460-2725

Shih‐Hua Lin, Yea‐Jen Hsu, Jainn-Shiun Chiu, Shi-Jye Chu, Mogamat Razeen Davids, Mitchell L. Halperin,

Renal function and acid-base balance

Osmotic demyelination of the brain (ODS) is a dreaded complication that typically occurs several days after aggressive therapy for chronic hyponatraemia, but is eminently avoidable. In this teaching exercise, Professor McCance, an imaginary consultant, is asked to explain how he would have treated a 28-year-old female who had hyperkalaemia, hypoglycaemia, hypotension and hyponatraemia (118 mM) to prevent the development of ODS. He begins with a review of the physiology, including his own landmark work on chronic hyponatraemia associated with a contracted extracellular fluid volume. Adding quantitative analysis, the cause of the excessive rise in plasma sodium concentration is revealed, and a better plan for therapy is proposed.