A Case of Central Pontine Myelinolysis Occurred During Treatment of Hyperosmolar Hyperglycemic Syndrome.
central pontine myelinolysis
diabetes mellites
hypernatremia
hyperosmolar hyperglycemic syndrome
Journal
International medical case reports journal
ISSN: 1179-142X
Titre abrégé: Int Med Case Rep J
Pays: New Zealand
ID NLM: 101566269
Informations de publication
Date de publication:
2021
2021
Historique:
received:
25
04
2021
accepted:
04
06
2021
entrez:
28
6
2021
pubmed:
29
6
2021
medline:
29
6
2021
Statut:
epublish
Résumé
Central pontine myelinolysis (CPM) is a rare demyelinating condition which has been reported to occur in a variety of clinical settings, but most commonly in association with a rapid rise in plasma osmolality during correction of chronic hyponatremia. The clinical consequences can vary from a mild motor weakness that resolves completely over time to the devastating locked-in syndrome. In this presentation, we report a case of hyperosmolar hyperglycemic syndrome (HHS) with ponto-occipital disintegration. A 71-year-old female was transferred to our ER by an ambulance due to consciousness disorder and continuous fever for 10 days. We diagnosed septic shock caused by urinary tract infection (UTI), cerebral multiple infarctions, acute kidney injury (AKI) and HHS without treatment for diabetes. Then, we started therapeutic interventions for them based on the guideline with severe control for blood sugar (BS; primary 1635 mg/dl) under insulin therapy and hypernatremia (primary 153 mEq/l) under crystal infusion control in advanced care unit, apparently on routine lab data. However, the initial serum sodium value of 153 mEq/l was slowly compensated to 148 mEq/l in 60 hours under guideline on routine lab data, the initial compensated sodium value with osmolality was changed from 178 mEq/l to 150 mEq/l in the period. She recovered from her primary diagnosis and unconsciousness. After stabilized sepsis and HHS, we detected CPM on brain MRI due to following up multiple cerebral infarctions with left leg paralysis and verbal disorder. She gradually recovered over several months with intensive rehabilitation and eventually regained near normal functional capacity with stabilized BS. When we consider HHS with hypernatremia, it may be necessary to pay attention to not only to BS control and sodium control according to the guideline but also to osmolality changes to prevent CPM.
Identifiants
pubmed: 34177275
doi: 10.2147/IMCRJ.S316943
pii: 316943
pmc: PMC8219389
doi:
Types de publication
Case Reports
Langues
eng
Pagination
407-412Informations de copyright
© 2021 Niida et al.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest in this work.
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