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Central Pontine Myelinolysis and the Rate of Correction of Hyponatremia

R. F. Gledhill, MD, MRCP; P. D. Thompson, MB, FRACP
Arch Neurol. 1989;46(4):359-359. doi:10.1001/archneur.1989.00520400013005
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To the Editor.  —In describing a patient with central pontine myelinolysis (CPM) and behavioral symptoms, Price and Mesulam1 considered the development of CPM to be related to the rapid correction of hyponatremia. The serum sodium concentration in this patient on admission was 114 mmol/L and 17 hours later it was 133 mmol/L, yielding a calculated rate of correction of 1.12 mmol/L/h. That being so, we find it curious that, in discussing their case, the authors quote rates of correction (for sodium concentrations of ≤105 mmol/L) of 2 mmol/L/h2 as being advisable. Indeed, from their own experience, we would have expected them to have joined the vanguard advocating a slower rate of correction,3,4 particularly as the only symptom of hyponatremia in their patient was orthostatic hypotension. Thus, in a situation of this nature it might have been preferable to increase the serum sodium concentration at a rate not

REFERENCES

Price BH, Mesulam MM:  Behavioral manifestations of central pontine myelinolysis . Arch Neurol 1987;;44:671-673.
Ayus JC, Krothapalli RK, Arieff AI:  Changing concepts in the treatment of severe symptomatic hyponatremia . Am J Med 1985;;78:897-902.
Norenberg MD, Leslie KO, Robertson AS:  Association between rise in serum sodium and central pontine myelinolysis . Arch Neurol 1982;;11:128-135.
Sterns RH, Riggs JE, Schochet SS Jr:  Osmotic demyelination syndrome following correction of hyponatremia . N Engl J Med 1986;;314:1535-1542.
Valenstein E, Watson RT, Quisling RG:  Neostriatal lesions in the osmotic demyelination (sic) . Neurology 1987;;37( (suppl 1) ):178.
Grafton ST, Bahls F, Bell KR:  Acquired dystonia following central pontine myelinolysis . Neurology 1987;;37( (suppl 1) ):276.
Redmond J, Brunner J, Haggar A, et al:  Central pontine myelinolysis: Evolution following correction of hyponatremia shown by MRI . Neurology 1987;;37( (suppl 1) ):306.
Narins RG:  Therapy of hyponatremia: Does haste make waste? N Engl J Med 1986;;314:1573-1574.
Worthley LIG, Thomas PD:  Treatment of hyponatraemic seizures with intravenous 29.2% saline . Br Med J 1986;;1:168-170.

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Price BH, Mesulam MM:  Behavioral manifestations of central pontine myelinolysis . Arch Neurol 1987;;44:671-673.
Ayus JC, Krothapalli RK, Arieff AI:  Changing concepts in the treatment of severe symptomatic hyponatremia . Am J Med 1985;;78:897-902.
Norenberg MD, Leslie KO, Robertson AS:  Association between rise in serum sodium and central pontine myelinolysis . Arch Neurol 1982;;11:128-135.
Sterns RH, Riggs JE, Schochet SS Jr:  Osmotic demyelination syndrome following correction of hyponatremia . N Engl J Med 1986;;314:1535-1542.
Valenstein E, Watson RT, Quisling RG:  Neostriatal lesions in the osmotic demyelination (sic) . Neurology 1987;;37( (suppl 1) ):178.
Grafton ST, Bahls F, Bell KR:  Acquired dystonia following central pontine myelinolysis . Neurology 1987;;37( (suppl 1) ):276.
Redmond J, Brunner J, Haggar A, et al:  Central pontine myelinolysis: Evolution following correction of hyponatremia shown by MRI . Neurology 1987;;37( (suppl 1) ):306.
Narins RG:  Therapy of hyponatremia: Does haste make waste? N Engl J Med 1986;;314:1573-1574.
Worthley LIG, Thomas PD:  Treatment of hyponatraemic seizures with intravenous 29.2% saline . Br Med J 1986;;1:168-170.

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