Ver el código de «Osmotic demyelination syndrome»

==Background==
*Formerly called "central pontine myelinolysis"
*A neurologic condition caused by rapid correction of hyponatremia, with starting serum sodium normally 120 meq/L or less
*Caused by rapid correction of hyponatremia (>12 mEq/L/24 h), as water moves from cells to extracellular fluid, yielding intracellular dehydration.  
*Symptoms are often irreversible or only partially reversible

===Risk Factors===
*Chronic [[heart failure]]
*[[Alcoholism]]
*[[Cirrhosis]]
*[[Hypokalemia]]
*[[Malnutrition]]
*Treatment with vasopressin antagonists (e.g. tolvaptan)

===Risk Factors for Over-correction<ref>George, J. C., Zafar, W., Bucaloiu, I. D., & Chang, A. R. (2018). Risk Factors and Outcomes of Rapid Correction of Severe Hyponatremia. Clinical Journal of the American Society of Nephrology: CJASN, 13(7), 984–992.</ref>===
*Lower initial sodium
*[[Schizophrenia]]
*Lower baseline urine sodium

==Clinical Features==
''Symptoms can be present 2-6 days after rapid correction of serum sodium''  
*[[Dysarthria]]
*[[Dysphagia]]
*[[Lethargy]]
*Behavioral disturbances/ confusion
*[[weakness|Paraparesis]] or quadriparesis
*[[Seizures]]
*"Locked in" syndrome
*[[Coma]] and [[death]]

==Differential Diagnosis==
{{AMS DDX}}

==Evaluation==
*Evaluate for alternative/reversible causes of AMS or exacerbating factors
*MRI can be used to visualize the pontine lesion, with a characteristic "batwing" lesion of the pons appearing in typical cases

==Management<ref>Sterns RH and Hix JK. Overcorrection of hyponatremia is a medical emergency. Kidney International. Volume 76, Issue 6, 2 September 2009, Pages 587-589.</ref>==
*[[Desmopressin]] at 2 mcg q6 hrs IV/SC
*6 mL/kg of 5% dextrose in water, repeated until serum sodium rise back below 9 mEq in 24 hrs

==Disposition==
*Admit

==Prevention==
See [[hyponatremia]] for safe correction rate

==See Also==
*[[Hyponatremia]]

==References==
<references/>

[[Category:Neurology]]
[[Category:FEN]]