Neuro

Cerebral Demyelination Syndrome

search

Cerebral Demyelination Syndrome, Central Pontine Myelinolysis, Osmotic Demyelination Syndrome

  • Pathophysiology
  1. Lethal Cerebral edema from rapid electrolyte correction
    1. Over-correction of Serum Sodium
    2. Too rapid correction of Serum Sodium
  2. Related to chronicity of electrolyte disturbance
    1. Associated with rapid Sodium correction in chronic Hyponatremia (present >48 hours)
    2. Not associated with correction of acute Hyponatremia (esp. <24 hours)
      1. Severe symptomatic Hyponatremia (esp. <120 mEq/L) requires rapid Sodium replacement
  • Prevention
  1. In chronic Hyponatremia, do not correct Sodium >0.5 mEq/h or >12 mEq/day
  2. Some recommend limiting daily maximum correction to 6 mEq/day
  • References
  1. Le and Drogell (2015) Crit Dec Emerg Med 29(11): 13-19