Miðbrúar- og utanbrúarafmýling í kjölfar leiðréttingar svæsinnar blóðnatríumlækkunar : sjúkratilfelli og yfirlitsgrein
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Issue Date
2008-10-01
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Central and extrapontine myelinolysis following correction of extreme hyponatremia. Case report and review of the literatureCitation
Læknablaðið 2008, 94(10):665-71Abstract
We report a case of a 43-year-old woman who developed osmotic demyelination syndrome following correction of extreme hyponatremia that was considered to be of chronic nature. The serum sodium level was 91 mmol/L on admission to hospital. It was decided to correct the serum sodium slowly with the goal that the rate of correction would be no more than 12 mmol/l per 24 hours. This was achieved during the first two days of treatment but during the third day the rise in serum sodium was 13 mmol/l. On the 11th day of admission the patient had developed manifestations of pseudobulbar palsy and spastic quadriparesis. Magnetic resonance imaging study confirmed central and extrapontine myelonolysis. The patient received supportive therapy and eventually made full recovery. Current concepts in the pathophysiology of osmotic demyelination syndrome and the treatment of hyponatremia are reviewed. We recommend that the rate of correction of chronic hyponatremia should not exceed 8 mmol/l per 24 hours.Við greinum frá 43 ára gamalli konu sem fékk osmósuafmýlingarheilkenni (osmotic demyelination syndrome) í kjölfar leiðréttingar sérlega svæsinnar blóðnatríumlækkunar sem álitin var af langvinnum toga. Styrkur natríums í sermi var aðeins 91 mmól/l við komu á sjúkrahús. Stefnt var að hægfara leiðréttingu natríumlækkunarinnar og var markmiðið að hraði leiðréttingar yrði ekki meiri en 12 mmól/l á sólarhring. Það tókst fyrstu tvo daga meðferðar en á þriðja degi hækkaði natríumstyrkurinn um 13 mmól/l. Á 11. degi reyndist konan komin með merki um sýndarmænukylfulömun (pseudobulbar palsy) ásamt stjarfaferlömun (spastic quadriparesis) og staðfesti segulómmyndun miðbrúar- og utanbrúarafmýlingarskemmdir. Konan fékk almenna stuðningsmeðferð og náði smám saman fullum bata. Fjallað er um meinalífeðlisfræði osmósuafmýlingarheilkennis og meðferð blóðnatríumlækkunar. Við mælum með að hraði leiðréttingar langvinnrar blóðnatríumlækkunar sé ekki umfram 8 mmól/l á sólarhring.
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