SHM Converge Scientific Abstract ePoster Gallery-Managing Expectations: Severe Hyponatremia Complicated by Osmotic Demyelination Syndrome

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This case describes a 34-year-old underweight man with hypertension on chlorthalidone and a recent COVID-19 infection who presented with shortness of breath and diarrhea. Initial evaluation showed severe hypo-osmolar hyponatremia and hypokalemia, and he was admitted for cautious correction. His sodium was managed conservatively with hypertonic saline, then sodium chloride tablets and desmopressin to avoid overly rapid correction.<br /><br />Despite apparently appropriate treatment and adherence to recommended safety limits, he had multiple risk factors for osmotic demyelination syndrome (ODS) and returned three days after discharge with worsening fatigue, slowed speech, and involuntary clenching of the hands and jaw. Brain MRI showed findings consistent with extra-pontine myelinolysis, including bilateral basal ganglia involvement, while the pons was relatively spared.<br /><br />He declined plasmapheresis and instead received supportive care before discharge to acute rehabilitation. At two-month follow-up, his MRI remained unchanged, but he reported no residual neurologic or physical deficits.<br /><br />The discussion emphasizes that ODS remains a rare but serious complication of sodium correction, with an estimated prevalence of 0.25–0.5%. Symptoms are often delayed and may include dysarthria, movement disorders, seizures, obtundation, and coma. Diagnosis relies on compatible clinical findings plus MRI evidence of pontine and/or extra-pontine demyelination. Recommended preventive strategies include limiting sodium correction to no more than 8 mmol/L in 24 hours and 18 mmol/L in 48 hours, and using desmopressin when needed to prevent overcorrection. Treatment options include early re-lowering of sodium, plasmapheresis, and supportive care. The case highlights that even guideline-based management does not eliminate risk, so clinicians should carefully manage expectations for outcomes.

Asset Subtitle

Hong Yu Wang

Meta Tag

Author List Geetika Arora, Hong Yu Wang, Patricia Dharapak, Priyanka Sridhar

Category Clinical Vignettes

Concept Osmotic Demyelination Syndrome

Concept Hyponatremia

Concept Serum Sodium Correction

Concept Correction Limits

Concept Neurological Manifestation

Distinguished Non-Finalist

Presenter Organization Mount Sinai West and Morningside

Presenting Author Hong Yu Wang

Track Adult

Keywords

osmotic demyelination syndrome

hyponatremia

hypokalemia

hypertonic saline

desmopressin

chlorthalidone

extra-pontine myelinolysis

basal ganglia

MRI findings

sodium correction

Osmotic Demyelination Syndrome

Hyponatremia

Serum Sodium Correction

Correction Limits

Neurological Manifestation