II. Pathophysiology

  1. Lethal Cerebral edema from rapid electrolyte correction
    1. Over-correction of Serum Sodium
    2. Too rapid correction of Serum Sodium
  2. Related to chronicity of electrolyte disturbance
    1. Associated with rapid Sodium correction in chronic Hyponatremia (present >48 hours)
    2. Not associated with correction of acute Hyponatremia (esp. <24 hours)
      1. Severe symptomatic Hyponatremia (esp. <120 mEq/L) requires rapid Sodium replacement

III. Prevention

  1. In chronic Hyponatremia, do not correct Sodium >0.5 mEq/h or >12 mEq/day
  2. Some recommend limiting daily maximum correction to 6 mEq/day

IV. References

  1. Le and Drogell (2015) Crit Dec Emerg Med 29(11): 13-19

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Ontology: Myelinolysis, Central Pontine (C0206083)

Definition (NCI) A central nervous system disorder caused by demyelination within the central basis pontis of the brain. It is characterized by spastic quadriplegia, pseudobulbar palsy and encephalopathy. It is observed in patients with severe hyponatremia, particularly when the hyponatremia is corrected too rapidly.
Definition (MSH) A demyelinating condition affecting the PONS and characterized clinically by an acute progressive QUADRIPLEGIA; DYSARTHRIA; DYSPHAGIA; and alterations of consciousness. Pathologic features include prominent demyelination in the central PONS with sparing of axons and neurons. This condition is usually associated with systemic disorders such as HYPONATREMIA; chronic ALCOHOLISM; LIVER FAILURE; severe BURNS; malignant NEOPLASMS; hemorrhagic PANCREATITIS; HEMODIALYSIS; and SEPSIS. The rapid medical correction of hyponatremia has been cited as a cause of this condition. (From Adams et al., Principles of Neurology, 6th ed, pp1125-6)
Concepts Disease or Syndrome (T047)
MSH D017590
ICD10 G37.2
SnomedCT 6807001
English Central Pontine Myelinolysis, Myelinoclasis, Central Pontine, Pontine Myelinolysis, Central, Myelinolysis, Central Pontine, Central Pontine Myelinoclasis, central pontine myelinolysis (diagnosis), central pontine myelinolysis, Central pontine myelolysis, Myelinolysis, Central Pontine [Disease/Finding], central pontine myelinosis, Central pontine myelinolysis, Central pontine myelinolysis (disorder), myelinolysis; pontine, central, Central pontine myelinosis
Swedish Myelinolys, central pontin
Finnish Sentraalinen aivosillan myelinolyysi
Russian VAROLIEVA MOSTA TSENTRAL'NYI MIELINOLIZ, DEMIELINIZATSIIA TSENTRAL'NAIA VAROLIEVA MOSTA, ОСМОТИЧЕСКИЙ ДЕМИЕЛИНИЗИРУЮЩИЙ СИНДРОМ, MIELINOLIZ TSENTRAL'NYI VAROLIEVA MOSTA, МИЕЛИНОЛИЗ ЦЕНТРАЛЬНЫЙ ПОНТИННЫЙ, MIELINOLIZ TSENTRAL'NYI PONTINNYI, МИЕЛИНОЛИЗ ЦЕНТРАЛЬНЫЙ ВАРОЛИЕВА МОСТА, OSMOTICHESKII DEMIELINIZIRUIUSHCHII SINDROM, ВАРОЛИЕВА МОСТА ЦЕНТРАЛЬНЫЙ МИЕЛИНОЛИЗ, ДЕМИЕЛИНИЗАЦИЯ ЦЕНТРАЛЬНАЯ ВАРОЛИЕВА МОСТА
Japanese 橋中心髄鞘崩壊, 髄鞘崩壊症-橋中心, 橋ミエリン溶解-中央, ミエリン溶解-橋中央, キョウチュウシンズイショウホウカイショウ, 橋中心髄鞘崩壊症, 橋中央ミエリン溶解
Korean 중심성 교탈수초증
Spanish Mielosis pontina central, Mielinólisis pontina central, mielinólisis pontina central (trastorno), mielinólisis pontina central, Mielinólisis Pontino Central
Portuguese Mielinóse pontina central, Mielinólise pôntica central, Mielinólise Central da Ponte, Mielinólise Central Pontina
French Myélolyse centrale du pont, Myélinolyse centropontique, Démyélinisation de la protubérance annulaire, Myélinolyse centrale du pont de Varole, Myélinolyse centrale du pont, Myélinolyse centropontine, Myélinolyse centro-pontine, Myélinolyse centro-pontique
Italian Mielinolisi centrale pontina, Mielinolisi pontina centrale
German Zentral pontine Myelinolyse, zentrale pontine Myelolyse, Myelinolyse, zentrale pontine, Pontine Myelinolyse, zentrale, Zentrale pontine Myelinolyse, Myelinoklasie, zentrale pontine
Dutch centrale pontine myelinolyse, centrale pontine myelolyse, myelinolyse; pontien centraal, Centraal pontiene myelinolyse, Myelinolyse, centraal pontiene, Pontiene myelinolyse, centraal
Czech Centrální pontinní myelinolýza, centrální pontinní myelinolýza, pons - myelinolýza
Polish Mielinoliza mostu środkowa
Hungarian Centralis pontin myelinolysis, Centralis pontin myelolysis
Norwegian Sentral pontin myelinolyse

Ontology: Osmotic demyelination syndrome (C2721559)

Concepts Disease or Syndrome (T047)
English Osmotic demyelination syndrome
Spanish Síndrome de desmielinización osmótica
Portuguese Síndrome de desmielinização osmótica
French Syndrome de démyélinisation osmotique
Italian Sindrome da demielizzazione osmotica
German Osmotisches Demyelinationssyndrom
Dutch osmotische-demyelinisatiesyndroom
Czech Osmotický demyelinizační syndrom
Japanese シントウアツセイダツズイショウコウグン, 浸透圧性脱髄症候群
Hungarian Ozmotikus demyelinatio syndroma