Therapeutic challenges in the management of osmotic demyelination syndrome
| Autor: | Elshafei, Mohamed, Danjuma, Mohammed I., Tahir, Rania El |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Lethargy
Male Saline Solution Hypertonic hyponatremia Antidiuretic Agents Iatrogenic Disease Osmolar Concentration Sodium osmotic Brain Middle Aged Magnetic Resonance Imaging Glucose Treatment Outcome Sweetening Agents Humans Deamino Arginine Vasopressin Drug Therapy Combination Clinical Case Report demyelination Tomography X-Ray Computed Research Article Demyelinating Diseases |
| Zdroj: | Medicine |
| ISSN: | 1536-5964 0025-7974 |
| Popis: | Rationale: 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. Patient concerns: 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. Diagnosis: 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. Intervention: Concomitant administration of 5% dextrose water with desmopressin with a therapeutic objective of gradual relowering of serum sodium concentration. Outcomes: Significant improvement in patients’ conscious level and motor function with the commencement of sodium relowering therapy. The patient was eventually discharged home. Lessons: 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. |
| Databáze: | OpenAIRE |
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