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

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Presentation on theme: "What is the complication of the rapid correction of the hyponatremia?"— Presentation transcript:

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.


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