Osmotic demyelination syndrome - Revision history

Kxl328: /* ManagementSterns RH and Hix JK. Overcorrection of hyponatremia is a medical emergency. Kidney International. Volume 76, Issue 6, 2 September 2009, Pages 587-589. */

2021-08-27T23:19:14Z

ManagementSterns RH and Hix JK. Overcorrection of hyponatremia is a medical emergency. Kidney International. Volume 76, Issue 6, 2 September 2009, Pages 587-589.

← Older revision		Revision as of 23:19, 27 August 2021
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	*[[Desmopressin]] at 2 mcg q6 hrs IV/SC		*[[Desmopressin]] at 2 mcg q6 hrs IV/SC
	*6 mL/kg of 5% dextrose in water, repeated until serum sodium rise back below 9 mEq in 24 hrs		*6 mL/kg of 5% dextrose in water, repeated until serum sodium rise back below 9 mEq in 24 hrs
			*If concerns for iatrogenic rapid increase in serum Na concentration (IV crystalloid bolus before Na lab comes back):
			**Stop IV fluids, send urine osmolality, repeat serum Na
			**If uOsm is < 100 mOsm/L, this suggests free water diuresis
			**Or if sodium appears to be on a trajectory to increase >8mEq/L in 24hrs
			**Administer DDAVP 1 mcg x1

	==Disposition==		==Disposition==

Kxl328: /* Evaluation */

2021-08-27T23:18:53Z

Evaluation

← Older revision		Revision as of 23:18, 27 August 2021
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	==Evaluation==		==Evaluation==
	*If concerns for iatrogenic rapid increase in serum Na concentration (IV crystalloid bolus before Na lab comes back):
	**Stop IV fluids, send urine osmolality, repeat serum Na
	**If uOsm is < 100 mOsm/L, this suggests free water diuresis
	**Or if sodium appears to be on a trajectory to increase >8mEq/L in 24hrs
	**Administer DDAVP 1 mcg x1
	*Evaluate for alternative/reversible causes of AMS or exacerbating factors		*Evaluate for alternative/reversible causes of AMS or exacerbating factors
	*[[brain MRI\|MRI]] can be used to visualize the pontine lesion, with a characteristic "batwing" lesion of the pons appearing in typical cases		*[[brain MRI\|MRI]] can be used to visualize the pontine lesion, with a characteristic "batwing" lesion of the pons appearing in typical cases

Kxl328: /* Evaluation */

2021-08-27T23:18:24Z

Evaluation

← Older revision		Revision as of 23:18, 27 August 2021
Line 33:		Line 33:

	==Evaluation==		==Evaluation==
			*If concerns for iatrogenic rapid increase in serum Na concentration (IV crystalloid bolus before Na lab comes back):
			**Stop IV fluids, send urine osmolality, repeat serum Na
			**If uOsm is < 100 mOsm/L, this suggests free water diuresis
			**Or if sodium appears to be on a trajectory to increase >8mEq/L in 24hrs
			**Administer DDAVP 1 mcg x1
	*Evaluate for alternative/reversible causes of AMS or exacerbating factors		*Evaluate for alternative/reversible causes of AMS or exacerbating factors
	*[[brain MRI\|MRI]] can be used to visualize the pontine lesion, with a characteristic "batwing" lesion of the pons appearing in typical cases		*[[brain MRI\|MRI]] can be used to visualize the pontine lesion, with a characteristic "batwing" lesion of the pons appearing in typical cases

Elcatracho: /* See Also */

2021-02-10T15:37:52Z

ClaireLewis: /* Evaluation */

2019-10-02T01:00:57Z

Evaluation

← Older revision		Revision as of 01:00, 2 October 2019
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	==Evaluation==		==Evaluation==
	*Evaluate for alternative/reversible causes of AMS or exacerbating factors		*Evaluate for alternative/reversible causes of AMS or exacerbating factors
	*MRI can be used to visualize the pontine lesion, with a characteristic "batwing" lesion of the pons appearing in typical cases		*[[brain MRI\|MRI]] can be used to visualize the pontine lesion, with a characteristic "batwing" lesion of the pons appearing in typical cases

	==Management<ref>Sterns RH and Hix JK. Overcorrection of hyponatremia is a medical emergency. Kidney International. Volume 76, Issue 6, 2 September 2009, Pages 587-589.</ref>==		==Management<ref>Sterns RH and Hix JK. Overcorrection of hyponatremia is a medical emergency. Kidney International. Volume 76, Issue 6, 2 September 2009, Pages 587-589.</ref>==

ClaireLewis at 16:30, 29 September 2019

2019-09-29T16:30:01Z

← Older revision		Revision as of 16:30, 29 September 2019
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	===Risk Factors===		===Risk Factors===
	*Chronic heart failure		*Chronic [[heart failure]]
	*[[Alcoholism]]		*[[Alcoholism]]
	*[[Cirrhosis]]		*[[Cirrhosis]]
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	===Risk Factors for Over-correction<ref>George, J. C., Zafar, W., Bucaloiu, I. D., & Chang, A. R. (2018). Risk Factors and Outcomes of Rapid Correction of Severe Hyponatremia. Clinical Journal of the American Society of Nephrology: CJASN, 13(7), 984–992.</ref>===		===Risk Factors for Over-correction<ref>George, J. C., Zafar, W., Bucaloiu, I. D., & Chang, A. R. (2018). Risk Factors and Outcomes of Rapid Correction of Severe Hyponatremia. Clinical Journal of the American Society of Nephrology: CJASN, 13(7), 984–992.</ref>===
	*Lower initial sodium		*Lower initial sodium
	*Schizophrenia		*[[Schizophrenia]]
	*Lower baseline urine sodium		*Lower baseline urine sodium

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	*[[Dysarthria]]		*[[Dysarthria]]
	*[[Dysphagia]]		*[[Dysphagia]]
	*Lethargy		*[[Lethargy]]
	*Behavioral disturbances/ confusion		*Behavioral disturbances/ confusion
	*Paraparesis or quadriparesis		*[[weakness\|Paraparesis]] or quadriparesis
	*[[Seizures]]		*[[Seizures]]
	*"Locked in" syndrome		*"Locked in" syndrome

ClaireLewis at 00:15, 27 January 2019

2019-01-27T00:15:52Z

← Older revision		Revision as of 00:15, 27 January 2019
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	==Evaluation==		==Evaluation==
			*Evaluate for alternative/reversible causes of AMS or exacerbating factors
	*MRI can be used to visualize the pontine lesion, with a characteristic "batwing" lesion of the pons appearing in typical cases		*MRI can be used to visualize the pontine lesion, with a characteristic "batwing" lesion of the pons appearing in typical cases

	==Management<ref>Sterns RH and Hix JK. Overcorrection of hyponatremia is a medical emergency. Kidney International. Volume 76, Issue 6, 2 September 2009, Pages 587-589.</ref>==		==Management<ref>Sterns RH and Hix JK. Overcorrection of hyponatremia is a medical emergency. Kidney International. Volume 76, Issue 6, 2 September 2009, Pages 587-589.</ref>==
	*Desmopressin at 2 mcg q6 hrs IV/SC		*[[Desmopressin]] at 2 mcg q6 hrs IV/SC
	*6 mL/kg of 5% dextrose in water, repeated until serum sodium rise back below 9 mEq in 24 hrs		*6 mL/kg of 5% dextrose in water, repeated until serum sodium rise back below 9 mEq in 24 hrs

Kxl328: /* Management */

2018-11-06T17:51:53Z

Management

← Older revision		Revision as of 17:51, 6 November 2018
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	*MRI can be used to visualize the pontine lesion, with a characteristic "batwing" lesion of the pons appearing in typical cases		*MRI can be used to visualize the pontine lesion, with a characteristic "batwing" lesion of the pons appearing in typical cases

	==Management==		==Management<ref>Sterns RH and Hix JK. Overcorrection of hyponatremia is a medical emergency. Kidney International. Volume 76, Issue 6, 2 September 2009, Pages 587-589.</ref>==
			*Desmopressin at 2 mcg q6 hrs IV/SC
			*6 mL/kg of 5% dextrose in water, repeated until serum sodium rise back below 9 mEq in 24 hrs

	==Disposition==		==Disposition==

Mrosen5506: /* Risk Factors */

2018-08-11T17:39:54Z

Risk Factors

← Older revision		Revision as of 17:39, 11 August 2018
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	*[[Malnutrition]]		*[[Malnutrition]]
	*Treatment with vasopressin antagonists (e.g. tolvaptan)		*Treatment with vasopressin antagonists (e.g. tolvaptan)

			===Risk Factors for Over-correction<ref>George, J. C., Zafar, W., Bucaloiu, I. D., & Chang, A. R. (2018). Risk Factors and Outcomes of Rapid Correction of Severe Hyponatremia. Clinical Journal of the American Society of Nephrology: CJASN, 13(7), 984–992.</ref>===
			*Lower initial sodium
			*Schizophrenia
			*Lower baseline urine sodium

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* See Also */

2017-10-31T12:50:48Z

← Older revision		Revision as of 15:37, 10 February 2021
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	==See Also==		==See Also==
	*[[Hyponatremia]]		*[[Hyponatremia]]
			*[[Hypernatremia]]

	==References==		==References==

← Older revision		Revision as of 12:50, 31 October 2017
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	==See Also==		==See Also==
			*[[Hyponatremia]]

	==References==		==References==