Therapeutic challenges in the management of osmotic demyelination syndrome
<h3>Rationale</h3><p dir="ltr">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.</p><h3>Patient concerns</h3><...
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2020
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| Summary: | <h3>Rationale</h3><p dir="ltr">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.</p><h3>Patient concerns</h3><p dir="ltr">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.</p><h3>Diagnosis</h3><p dir="ltr">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.</p><h3>Intervention</h3><p dir="ltr">Concomitant administration of 5% dextrose water with desmopressin with a therapeutic objective of gradual relowering of serum sodium concentration.</p><h3>Outcomes</h3><p dir="ltr">Significant improvement in patients’ conscious level and motor function with the commencement of sodium relowering therapy. The patient was eventually discharged home.</p><h3>Lessons</h3><p dir="ltr">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.</p><h2>Other Information</h2><p dir="ltr">Published in: Medicine<br>License: <a href="http://creativecommons.org/licenses/by/4.0" target="_blank">http://creativecommons.org/licenses/by/4.0</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1097/md.0000000000020283" target="_blank">https://dx.doi.org/10.1097/md.0000000000020283</a></p> |
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