Osmotic demyelination syndrome
You don't need to be Editor-In-Chief to add or edit content to WikiDoc. You can begin to add to or edit text on this WikiDoc page by clicking on the edit button at the top of this page. Next enter or edit the information that you would like to appear here. Once you are done editing, scroll down and click the Save page button at the bottom of the page.
| This article needs additional references or sources for verification. Please help improve this article by adding reliable references. Unverifiable material may be challenged and removed. |
| It has been suggested that this article or section be merged with Central pontine myelinolysis. (Discuss) |
Osmotic Demyelination Syndrome occurs with rapid correction of Hyponatremia. It is characterized by acute paralysis, dysarthria, dysphagia and other neurological symptoms.
Pathology
The currently accepted theory states that the brain cells adjust their osmolarities by changing levels of certain Osmolytes like Inositol, Betaine, Glutamine etc. In hyponatremia the levels of these osmolytes fall, preventing entry of free-water into cells. The reverse is true for hypernatremia. So rapid correction of Sodium in hyponatremia would cause the extra cellular fluid to be relatively hypertonic. Free-water would then move out of the cells. This leads to a central pontine myelinolysis, manifesting as the paralyses. Rapid correction of hypernatremia causes water to move into cells, leading to multiple cerebral hemorrhages, equally catastrophic as Osmotic Demyelination.
Management
There is no specific treatment and the syndrome is associated with high mortality and morbidity. This being a potentially avoidable disaster, following recommendations may be adhered to while maintaining sodium levels:
Hyponatremia: Correction rate=0.5-1.0meq/L/hr, with not more than 12meq/l correction in 24 hrs. If the patient has seizures (or [Na+]<115), correction can be attempted at up to 2meq/L/hr, but only till seizure activity lasts and [Na+] reaches above 125-130 meq/L.
Hypernatremia: Correct at 0.5meq/L/hr. Not more than 12 meq/L/24hrs.
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
