Osmotic myelinolysis following chronic hyponatremia corrected at an overall rate consistent with current recommendations

Int Urol Nephrol. 2005;37(1):171-3. doi: 10.1007/s11255-004-4770-9.


Rapid correction of chronic hyponatremia (CH) may lead to the development of osmotic myelinolysis (OM), a condition with high mortality and high incidence of devastating neurological sequelae. Treatment guidelines suggest "safe" overall rates of correction of serum sodium concentration ([Na](s)) over the first 24 and 48 hours of treatment of CH. We report a patient with CH who developed fatal OM despite overall rates of correction of [Na](s) that were within the recommended rates. The potential risk factors for the development of OM in this patient included short (within a few hours) rises in [Na](s) exceeding 0.5 mmol/l per hour and the presence of severe protein malnutrition. We suggest that the rate of correction of [Na](s) in CH should be uniformly slow and that the overall rate of correction should be slower than the currently recommended rate in severely malnourished patients.

Publication types

  • Case Reports
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Brain / pathology
  • Chronic Disease
  • Fatal Outcome
  • Humans
  • Hyponatremia / complications*
  • Hyponatremia / therapy
  • Infusions, Intravenous
  • Magnetic Resonance Imaging
  • Male
  • Myelinolysis, Central Pontine / diagnosis
  • Myelinolysis, Central Pontine / etiology*
  • Protein-Energy Malnutrition / complications
  • Sodium Chloride / administration & dosage*


  • Sodium Chloride