Extrapontine myelinolysis in severe hypernatremia despite controlled sodium correction: a case report

Srishti Katiyar; Rajat Saha

doi:10.18203/2320-6012.ijrms20263566

Authors

Srishti Katiyar Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
Rajat Saha Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20263566

Keywords:

Electrolyte disturbances, Extrapontine myelinosis, Hypernatremia, Neurology, Critical care, Osmotic demyelination syndrome

Abstract

Osmotic demyelination syndrome (ODS) is a condition characterized by sudden loss of myelin, typically triggered by rapid shifts in the body's osmotic balance. We report a 53-year-old male with recurrent carcinoma of the buccal mucosa who developed severe hypernatremia following sodium bicarbonate infusion. Despite careful and gradual correction of his elevated sodium levels, he subsequently developed quadriparesis, and MRI confirmed extrapontine myelinolysis. Supportive neurological, oncological, and hematological care was provided, but the patient ultimately succumbed to his illness. This case highlights that even cautious correction of sodium disturbances can precipitate ODS, particularly in patients with malignancy and metabolic stress, emphasizing the need for vigilant monitoring and individualized management.

References

Bataille S, Baralla C, Torro D, Buffat C, Berland Y, Alazia M, et al. Undercorrection of hypernatremia is frequent and associated with mortality. BMC Nephrol. 2014;15:37. doi:10.1186/1471-2369-15-37.

Pokhriyal SC, Joshi P, Gupta U, Roy P, Parkash S, Kunwar K, et al. Hypernatremia and its rate of correction: the evidence so far. Cureus. 2024;16(2):e54699

Bhatia S, Kapoor AK, Sharma A, Gupta R, Kataria S. Cerebral encephalopathy with extrapontine myelinolysis in a case of postpartum hypernatremia. Indian J Radiol Imaging. 2014;24(1):57-60.

Beraldo DO, Duarte SBCP, Santos RB, Mendes CG, Silveira MP, Neto AS, et al. Pontine myelinolysis caused by hypovolemic hypernatremia. Case Rep Nephrol. 2020;2020:1-4

Rajasekharan C, Renjith SW, Nishanth DT, Naseem YM, Parvathy R. Osmotic demyelination syndrome: why should hypernatremia be corrected slowly? A case report. J Adv Med Med Res. 2014;4(18):3512-8.

Levin J, Högen T, Patzig M, Pfister HW, Peters N. Pontine and extrapontine myelinolysis associated with hypernatremia. Clin Neurol Neurosurg. 2012;114(9):1290-1.

Adrogué HJ, Madias NE. Hypernatremia. N Engl J Med. 2000;342(20):1493-9.

Sonani B, Naganathan S, Al-Dhahir MA: Hypernatremia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 Available from: http://www.ncbi.nlm.nih.gov/books/NBK441960/.Accessed on 10 July 2025.

Feigin E, Feigin L, Ingbir M, Ben-Bassat OK, Shepshelovich D. Rate of correction and all-cause mortality in patients with severe hypernatremia. JAMA Netw Open. 2023;6(9):e2335415.