The Osmotic demyelination syndrome (ODS) primarily occurs with rapid correction of severe hyponatraemia that has been present for more than two or three days. Some patients are, however at risk and can develop ODS at higher sodium concentration and lower rates of correction. A case of Osmotic demyelination Syndrome which developed despite an ‘optimal’ rate of correction of serum Sodium with good clinical outcome is described. The risk factors that contribute to development of ODS and strategies to prevent this complication are discussed, along with recommendations on how to manage this condition in hospital inpatients.

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References

1. Sterns RH, Riggs JE, Schochet SS Jr. Osmotic demyelination syndrome following correction of hyponatremia. N Engl J Med 1986; 314: 1535-42
2. Norenberg MD, Leslie KO, Robertson AS. Association between rise in serum sodium and central pontine myelinolysis. Ann Neurol 1982; 11:128-35
3. Ayus JC, Krothapalli RK, Arieff AI. Treatment of symptomatic hyponatremia and its relation to brain damage. A prospective study. N Engl J Med 1987; 317:1190-5
4. Chason JL, Landers JW, Gonzalez JE. Central Pontine Myelinolysis. J Neurol Neurosurg Psychiatry 1964; 27:317-25
5. Goebel HH, Zur PH. Central pontine myelinolysis. A clinical and pathological study of 10 cases. Brain 1972; 95:495-504
6. Gocht A, Colmant HJ. Central pontine and extrapontine myelinolysis: a report of 58 cases. Clin Neuropathol 1987; 6:262-70
7. Adams RD, Victor M, Mancall EL. Central pontine myelinolysis: a hitherto under described disease occurring in alcoholic and malnourished patients. AMA Arch Neurol Psychiatry 1959; 81: 154-172
8. Singh TD, Fugate JE, Rabinstein AA. Central pontine and extrapontine myelinolysis: a systematic review. Eur J Neurol 2014; 21: 1443-50
9. Georgy V, Mulhi D, Jones AF. Central pontine myelinolysis following ‘optimal’ rate of correction of hyponatremia with good clinical outcome. Ann Clin Biochem 2007; 44: 488-90
10. Oster JR, Singer I. Hyponatremia, hyposmolality, and hypotonicity: tables and fables. Arch Intern Med 1999; 159:333
11. Sterns RH. Severe symptomatic hyponatremia: treatment and outcome. A study of 64 cases. Ann intern Med 1987; 107:656
12. Sterns RH, Capuccio JD, Silver SM, Cohen EP. Neurologic sequelae after treatment of severe hyponatremia: a multicenter perspective. J Am Soc Nephrol 1994; 4:1522
13. Verbalis JG, Goldsmith SR, Greenberg A, et al. Diagnosis, evaluation, and treatment of Hyponatremia: expert panel recommendations. Am J Med 2013; 126:S1-42
14. Spasovski G, Vanholder R, Allolio B et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol 2014; 170:G1-47
15. Cheng JC, Zikos D, Skopicki HA, et al. Long-term neurologic outcome in psychogenic water drinkers with severe symptomatic hyponatremia: the effect of rapid correction. Am j med 1990; 88:561
16. Berl T. Treating Hyponatremia: damned if we do and damn if we don’t. Kidney Int 1990; 37:1006
17. Karp BI, laureno R. Pontine and extrapontine myelinolysis: a neurologic disorder following rapid correction of hyponatremia. Medicine (Baltimore) 1993; 72:359
18. Brunner JE, Redmond JM, haggar AM, et al. Central pontine myelinolisis and pontine lesions after rapid correction of hyponatremia: a prospective magnetic resonance imaging study. Ann Neur 1990; 27:61
19. Soupart A, Ngassa M, Decaux G. Therapeutic relowering of the serum sodium in a patient after excessive correction of hyponatremia. Clin Nephrol 1999; 51:383
20. Oya S, Tsutsumi K, Ueki K, Kirino T. Reintroduction of hyponatremia to treat central pontine myelinolysis. Neurology 2001; 57:1931
21. Bibl D, Lampl C, Gabriel C, et al. Treatment of central pontine myelinolysis with therapeutic plasmapheresis. Lancet 1999; 353:1155