Clinical analysis for osmotic demyelination syndrome in patients with chronic hyponatremia
Background: Although osmotic demyelination syndrome (ODS) has been well known to be associated with a rapid correction of sodium (Na+) in patients with chronic hyponatremia, its risk factors and clinical outcomes have not been examined in Taiwan. Aim: The aim of the study was to analyze the underlyi...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2022-01-01
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| Series: | Journal of Medical Sciences |
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| Online Access: | http://www.jmedscindmc.com/article.asp?issn=1011-4564;year=2022;volume=42;issue=5;spage=199;epage=205;aulast= |
| _version_ | 1811342354193317888 |
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| author | Hsi-Chih Chen Chih-Chien Sung Yi-Chang Lin Lin-Chien Chan Shih-Hua Lin |
| author_facet | Hsi-Chih Chen Chih-Chien Sung Yi-Chang Lin Lin-Chien Chan Shih-Hua Lin |
| author_sort | Hsi-Chih Chen |
| collection | DOAJ |
| description | Background: Although osmotic demyelination syndrome (ODS) has been well known to be associated with a rapid correction of sodium (Na+) in patients with chronic hyponatremia, its risk factors and clinical outcomes have not been examined in Taiwan. Aim: The aim of the study was to analyze the underlying causes and overlooked risk factors in patients with ODS. Methods: We retrospectively collected chronic hyponatremic patients developing ODS and analyzed their clinical characteristics. Results: Fourteen patients (7 males and 7 females) with a mean age of 62.7 ± 17.9 years old were enrolled. Their underlying causes included gastrointestinal illness with poor intake (n = 7), chronic use of diuretics (n = 2), syndrome of inappropriate antidiuretic hormone (n = 2), pneumonia (n = 2), and hypopituitarism (n = 1). Their serum Na+ was 107.2 ± 1.2 mmol/L with mild hypokalemia (potassium 3.1 ± 7 mmol/L), hypoalbuminemia (albumin, 3.4 ± 0.6 g/dL), and hypophosphatemia (phosphorus, 2.3 ± 1.0 mg/dL). Their mean Na+ correction rate was 8.4 ± 9 mmol/L/day and most patients (60%) developed ODS in first 3 days. Their manifestations included delirium, seizures, unstable gait, aphasia, and drowsy consciousness. Brain magnetic resonance imaging demonstrated that 42.8% had isolated central pontine myelinolysis. Totally, 43% of ODS patients had unfavorable outcome with death and disability. In addition, patients with rapid Na+ correction rate (>12 mmol/L/day, n = 4) usually exhibited significant hypokalemia (2.5 ± 0.4 vs. 3.5 ± 0.7 mmol/L, P < 0.05) as compared with those without. Conclusion: Nutritional status and concurrent electrolyte deficiencies such as hypokalemia are major risk factors in patients with ODS. Clinicians should timely recognize these potential risks of ODS and reduce Na+ correction rate to avoid catastrophic outcomes. |
| first_indexed | 2024-04-13T19:10:03Z |
| format | Article |
| id | doaj.art-3a7b400fc20b4778b2d0f33e61b4a871 |
| institution | Directory Open Access Journal |
| issn | 1011-4564 |
| language | English |
| last_indexed | 2024-04-13T19:10:03Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Medical Sciences |
| spelling | doaj.art-3a7b400fc20b4778b2d0f33e61b4a8712022-12-22T02:33:51ZengWolters Kluwer Medknow PublicationsJournal of Medical Sciences1011-45642022-01-0142519920510.4103/jmedsci.jmedsci_165_21Clinical analysis for osmotic demyelination syndrome in patients with chronic hyponatremiaHsi-Chih ChenChih-Chien SungYi-Chang LinLin-Chien ChanShih-Hua LinBackground: Although osmotic demyelination syndrome (ODS) has been well known to be associated with a rapid correction of sodium (Na+) in patients with chronic hyponatremia, its risk factors and clinical outcomes have not been examined in Taiwan. Aim: The aim of the study was to analyze the underlying causes and overlooked risk factors in patients with ODS. Methods: We retrospectively collected chronic hyponatremic patients developing ODS and analyzed their clinical characteristics. Results: Fourteen patients (7 males and 7 females) with a mean age of 62.7 ± 17.9 years old were enrolled. Their underlying causes included gastrointestinal illness with poor intake (n = 7), chronic use of diuretics (n = 2), syndrome of inappropriate antidiuretic hormone (n = 2), pneumonia (n = 2), and hypopituitarism (n = 1). Their serum Na+ was 107.2 ± 1.2 mmol/L with mild hypokalemia (potassium 3.1 ± 7 mmol/L), hypoalbuminemia (albumin, 3.4 ± 0.6 g/dL), and hypophosphatemia (phosphorus, 2.3 ± 1.0 mg/dL). Their mean Na+ correction rate was 8.4 ± 9 mmol/L/day and most patients (60%) developed ODS in first 3 days. Their manifestations included delirium, seizures, unstable gait, aphasia, and drowsy consciousness. Brain magnetic resonance imaging demonstrated that 42.8% had isolated central pontine myelinolysis. Totally, 43% of ODS patients had unfavorable outcome with death and disability. In addition, patients with rapid Na+ correction rate (>12 mmol/L/day, n = 4) usually exhibited significant hypokalemia (2.5 ± 0.4 vs. 3.5 ± 0.7 mmol/L, P < 0.05) as compared with those without. Conclusion: Nutritional status and concurrent electrolyte deficiencies such as hypokalemia are major risk factors in patients with ODS. Clinicians should timely recognize these potential risks of ODS and reduce Na+ correction rate to avoid catastrophic outcomes.http://www.jmedscindmc.com/article.asp?issn=1011-4564;year=2022;volume=42;issue=5;spage=199;epage=205;aulast=hyponatremiaosmotic demyelination syndromerisk factorssodium correction rate |
| spellingShingle | Hsi-Chih Chen Chih-Chien Sung Yi-Chang Lin Lin-Chien Chan Shih-Hua Lin Clinical analysis for osmotic demyelination syndrome in patients with chronic hyponatremia Journal of Medical Sciences hyponatremia osmotic demyelination syndrome risk factors sodium correction rate |
| title | Clinical analysis for osmotic demyelination syndrome in patients with chronic hyponatremia |
| title_full | Clinical analysis for osmotic demyelination syndrome in patients with chronic hyponatremia |
| title_fullStr | Clinical analysis for osmotic demyelination syndrome in patients with chronic hyponatremia |
| title_full_unstemmed | Clinical analysis for osmotic demyelination syndrome in patients with chronic hyponatremia |
| title_short | Clinical analysis for osmotic demyelination syndrome in patients with chronic hyponatremia |
| title_sort | clinical analysis for osmotic demyelination syndrome in patients with chronic hyponatremia |
| topic | hyponatremia osmotic demyelination syndrome risk factors sodium correction rate |
| url | http://www.jmedscindmc.com/article.asp?issn=1011-4564;year=2022;volume=42;issue=5;spage=199;epage=205;aulast= |
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