ECE2018 Poster Presentations: Pituitary and Neuroendocrinology Pituitary - Clinical (101 abstracts)
Severe hypernatremia resulting in a locked-in syndrome
Julia Silva-Fernández 1 , Rafael García-Ruiz 2 , Francisco Javier Gómez-Alfonso 1 , Florentino Del Val-Zaballos 1 , Belvis Torres-Arroyo 1 , Paloma González-Lázaro 1 , Cristina Contreras-Pascual 1 , Álvaro García-Manzanares Vázquez de Agredos 1 & Inés Gómez-García 1
1Section of Endocrinolgy, Mancha Centro Hospital, Alcázar de San Juan, Spain; 2Section of Neurology, Mancha Centro Hospital, Alcázar de San Juan, Spain.
Introduction: Osmotic demyelination syndrome (ODS) is a well described, potentially devastating consequence of rapid alterations in plasma osmolality, classically occurring secondary to the excessively rapid correction of chronic hyponatraemia. We describe a case of diabetes insipidus (DI) resulting in a Locked-in syndrome (LIS) caused by a rapidly developing severe hypernatremia.
Case report: A 43-year-old woman was admitted to the Internal Medicine ward with a clinical diagnosis of urinary tract infection. Her past medical history included panhypopituitarism, DI without adipsia and multiple meningiomas secondary to craniopharyngioma treated with surgery and radiotherapy during childhood, without difficulties to control sodium level. On admission, sodium level was within the normal range (138 mEq/L (135-145)). Three days later her level of consciousness was diminished. Lumbar puncture and electroencephalogram excluded both encephalitis and non-convulsive status epilepticus. Blood examination revealed high sodium level (180 mEq/L). The patient was aggressively fluid resuscitated with normal saline and was administered intravenous desmopressin. With 24, 48 and 72 hours, serum sodium decreased to 168, 159 and 151 mEq/L respectively. But despite achieving normal sodium levels, her neurological condition didn’t improve. She could open her eyes spontaneously, but she couldn’t speak or follow orders, and she was otherwise quadriplegic, so a suspicion of a LIS was raised. A brain MRI showing hyperintense lesions in the brainstem confirmed the ODS as the cause for the LIS.
Conclusions: Although reports of severe hypernatremia resulting in a ODS are few, rapid alterations in plasma osmolality – rather than only the correction of hyponatremia – are real cause for it. Physicians involved in the management of patients with difficulty control of plasma osmolality should be extremely cautious with rapid changes, as the consequences can be devastating.
Article tools
My recent searches
My recently viewed abstracts
Authors
Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
© Bioscientifica 2024 |
Privacy policy |
Cookie settings
BiosciAbstracts
Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences.
Find out more