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A Case of Osmotic Demyelination Syndrome in a Patient with Severe Hyponatremia Complicated by Rhabdomyolysis

횡문근융해증이 합병된 중증 저나트륨혈증 환자에서 발생한 삼투성 탈수초 증후군 1예

  • Lee, Da Young (Department of Internal Medicine, Catholic University of Daegu School of Medicine) ;
  • Hong, Chang Woo (Department of Internal Medicine, Catholic University of Daegu School of Medicine) ;
  • Lee, In Hee (Department of Internal Medicine, Catholic University of Daegu School of Medicine)
  • 이다영 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 홍창우 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 이인희 (대구가톨릭대학교 의과대학 내과학교실)
  • Received : 2012.08.24
  • Accepted : 2012.09.27
  • Published : 2013.06.30

Abstract

Hyponatremia, the most common electrolyte disorder, has been rarely reported as causing rhabdomyolysis. Osmotic demyelination syndrome (ODS), a demyelinating disease of the central pons and/or other areas of the brain, is infrequently reported as associated with rapid correction of hyponatremia. This paper reports a case of ODS after correction of severe hyponatremia complicated by rhabdomyolysis. A 47-year-old female with a history of chronic alcoholism presented herself at the hospital with altered consciousness after three days of nausea and vomiting. She was on a thiazide diuretic for essential hypertension. Her blood tests upon her hospital admission showed hyponatremia ($Na^+$ 98 mEq/L), hypokalemia ($K^+$ 3.0 mEq/L), and elevation of her serum creatine phosphokinase (3,370 IU/L) with an increase in her serum myoglobin level 11,267 ng/mL). She was treated with intravenous fluid therapy that included isotonic and hypertonic salines along with potassium chloride. She became more alert, and her neurological condition gradually improved after the first five days of her therapy. On the ninth day after her admission, she developed progressive quadiaresis associated with dysarthria, dysphagia, and dystonia despite the resolution of her hyponatremia. Magnetic resonance imaging of her brain on 16th day revealed symmetrical areas of signal hyperintensity in her central pons, basal ganglia, and precentral gyrus in T2-weighted images, which are consistent with ODS. Her neurological symptoms steadily improved after six weeks with only supportive treatment and rehabilitation.

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  1. 저용량 polyethylene glycol 용액에 아스코르빈산을 첨가한 장정결제로 대장내시경 전처치 후 발생한 발작을 동반한 저나트륨혈증 vol.32, pp.1, 2013, https://doi.org/10.12701/yujm.2015.32.1.55