SHM Converge Scientific Abstract ePoster Gallery-Osmotic Demyelination Syndrome Caused by Hyperglycemia Hyperosmolar State

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A 40-year-old woman with type 2 diabetes and severe malnutrition presented with altered mental status and dysuria. She was found to have hyperglycemic hyperosmolar state (HHS) with a glucose of 1113 mg/dL and a low measured sodium that corrected to normal. She was treated with IV fluids and insulin.<br /><br />During hospitalization, she developed progressive bilateral leg weakness, urinary retention, bowel incontinence, flaccid rectal tone, dysphagia, and difficulty swallowing. MRI of the brain showed T2 hyperintensity in the pons, consistent with osmotic demyelination syndrome (ODS). Stroke, multiple sclerosis, and hypertensive encephalopathy were excluded. Her symptoms improved later in the hospital course, and she was discharged to a skilled nursing facility with supportive care and rehabilitation.<br /><br />ODS is classically associated with rapid correction of hyponatremia, but this case highlights that it can also occur in the setting of HHS, even without significant sodium shifts. Reported HHS-related ODS cases often involve glucose levels above 1000 mg/dL and rapidly progressive neurologic deficits such as weakness, dysarthria, dysphagia, sensory loss, or decreased consciousness. The proposed mechanism is injury from extreme hyperosmolality caused by severe hyperglycemia.<br /><br />The key clinical message is that hospitalists should consider ODS when patients with HHS develop new neurologic symptoms. Early MRI can help confirm the diagnosis and guide supportive treatment.

Asset Subtitle

Sarah Jawadi

Meta Tag

Author List Charles Pizanis, Craig McFarland, Sarah Jawadi

Category Clinical Vignettes

Concept Osmotic Demyelination Syndrome

Concept Hyperosmolar Hyperglycemic State

Concept Serum Osmolality

Concept Hyperglycemia

Concept Weakness

Distinguished Non-Finalist

Presenter Organization University of New Mexico School of Medicine, Department of Internal Medicine

Presenting Author Sarah Jawadi

Track Adult

Keywords

hyperglycemic hyperosmolar state

osmotic demyelination syndrome

type 2 diabetes

severe hyperglycemia

altered mental status

pontine T2 hyperintensity

dysphagia

bilateral leg weakness

urinary retention

MRI brain

Osmotic Demyelination Syndrome

Hyperosmolar Hyperglycemic State

Serum Osmolality

Hyperglycemia

Weakness