Indian Journal of Critical Care Case Report

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VOLUME 1 , ISSUE 2 ( September-October, 2022 ) > List of Articles

CASE REPORT

Central Pontine Myelinolysis without Rapid Changes in Sodium Level: Possible Association with Malnutrition, Hypophosphatemia and Hypokalemia

Ashwini M Suryawanshi, Dilip R Karnad, Ravindra M Ghawat, Aniruddha V More, Preetam Kalaskar

Keywords : Central pontine myelinolysis, Hyponatremia, Hypophosphatemia, Malnutrition

Citation Information : Suryawanshi AM, Karnad DR, Ghawat RM, More AV, Kalaskar P. Central Pontine Myelinolysis without Rapid Changes in Sodium Level: Possible Association with Malnutrition, Hypophosphatemia and Hypokalemia. 2022; 1 (2):40-41.

DOI: 10.5005/jp-journals-11006-0015

License: CC BY-NC 4.0

Published Online: 04-11-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Central pontine myelinolysis (CPM) is a rare demyelinating condition most commonly associated with a rapid rise in plasma osmolality, especially during the correction of chronic hyponatremia. The clinical consequences can vary from mild motor weakness to devastating locked-in syndrome (LIS). The condition has also been described in association with other conditions like alcoholism, an acquired immunodeficiency syndrome (AIDS), hepatic failure1 hypernatremia, hypophosphatemia,2,3 liver transplantation, and carbamate poisoning.4 We report a case of a 76-year-old female with carcinoma rectum with acute gastroenteritis, sepsis, and acute kidney injury who developed CPM, not related to rapid correction of hyponatremia, during recovery from the acute illness. Highlights: Central pontine myelinolysis (CPM), which is part of the osmotic demyelination syndrome (ODS), usually results from the rapid increase in plasma osmolality during the correction of chronic hyponatremia. The clinical consequences vary from mild motor weakness to devastating LIS. ODS has also been described in association with alcoholism, malnutrition, diabetes mellitus (DM), liver transplantation, and electrolyte abnormalities like hypernatremia, hypophosphatemia, and hypokalemia. A 76-year-old female with rectal adenocarcinoma was admitted with anorexia, prolonged diarrhea due to Clostridium difficile infection, malnutrition, and sepsis. She had hypophosphatemia, hypocalcemia, and hypoalbuminemia on admission and persistent hypokalemia due to profuse diarrhea. She developed CPM with no evidence of rapid correction of sodium. We postulate that CPM may have been a consequence of malnutrition, hypophosphatemia, and hypokalemia.


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