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Year : 2019  |  Volume : 4  |  Issue : 1  |  Page : 34-38

Hyponatremia correction causing extrapontine myelinolysis

1 Department of Neurosurgery, Government Medical College, Thrissur, Kerala, India
2 Department of Pulmonary Medicine, Government Medical College, Thrissur, Kerala, India

Correspondence Address:
Dr. Harsha Padikkal Veettil
Department of Pulmonary Medicine, Government Medical College, Thrissur - 680 596, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/bjhs.bjhs_19_19

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Rapid correction of hyponatremia will result in extrapontine myelinolysis (EPM). We report a case of 25-year-old male patient who presented with traumatic brain injury (TBI) causing left temporal extradural hematoma (EDH). EDH was managed conservatively. The patient had addiction to alcohol, tobacco smoking, paan (containing betel nuts), and some other addictive substances, details of which were not available. The patient's Glasgow Coma Scale (GCS) and serum sodium were normal at admission. On the 7th and 8th days, serum sodium was 107 and 101 milliequivalent/liter (meq/l), respectively, but GCS was normal. Slow infusion of 3% sodium chloride 100 ml was given on the 7th day and 200 ml on the 8th day. However, serum sodium was raised to 128 meq/l on the 10th day. On the 11th day, GCS was deteriorated and the patient developed quadriparesis. Magnetic resonance imaging (MRI) scan showed bilateral symmetrical basal ganglia T2-weighted hyperintensities suggestive of EPM. In severe hyponatremic patient, it is the rapid rise of serum sodium level which causes EPM. Rapid rise of serum sodium can occur even if hyponatremia was corrected with gradual addition of sodium. Consumption of alcohol and addictive substances contributed along with hyponatremia correction, to the development of EPM. Early detection of hyponatremia is the paramount factor in TBI to prevent the debilitating disease of EPM. MRI plays a crucial role in definite diagnosis of EPM.

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