1. What is the complication of the rapid correction of the hyponatremia?

2. Osmotic Demyelination Syndrome
“central pontine myelinolysis”
Demyelinating lesion in the brain that occurs with overly rapid correction of hyponatremia
Characterized by acute paralysis, dysphagia, and dysarthria
Most common in those with chronic hyponatremia (usually caused by alcoholism)
It is thought that alcoholics and malnourished patients have a general deficiency of organic osmolytes, which puts them at greater risk of cell shrinkage.

3. Osmotic Demyelination Syndrome
In normal individuals
Neurons adjust their osmolarities by changing levels of osmolytes (Inositol, Glutamine, etc.)
Hyponatremia
Levels of osmolytes fall which prevents entry of free-water into cells
Chronic Hyponatremia
Neurons adapt (moves water out and equilibrates extracellular and intracellular tonicities)

4. Osmotic Demyelination Syndrome
Rapid correction of Sodium
Tonicities are changed again
Causes extracellular fluid to be relatively hypertonic
Free water moves out
Too quick correction does not allow enough time for the neurons to adapt to the new tonicity
Osmotic Demyelination Syndrome
The rapid change in tonicity will continue to drive out water leading to cell shrinkage and dysfunction
Manifests as paralysis

5. Osmotic Demyelination Syndrome
Prevention: Correction rate= meq/L/hr, with not more than 12meq/l correction in 24 hrs; should receive no more than 8-10mmol of sodium per day
Management: Supportive
Prognosis is poor
Once demyelination has begun, there is no specific treatment. Care is supportive, with the goal of preventing complications like aspiration pneumonia or deep vein thrombosis. Alcoholics are usually given vitamins to correct for other deficiencies.