Extrapontine myelinolysis caused by rapid correction of pituitrin-induced severe hyponatremia: A case report  

作　　者：Liang-Jie Fang Ming-Wei Xu Jian-Ying Zhou Zhi-Jie Pan 

机构地区：[1]Department of Respiratory Medicine,First Affiliated Hospital,School of Medicine,Zhejiang University,Hangzhou 310009,Zhejiang Province,China [2]Department of Neurology,First Affiliated Hospital,School of Medicine,Zhejiang University,Hangzhou 310009,Zhejiang Province,China

出　　处：《World Journal of Clinical Cases》2020年第5期946-953,共8页世界临床病例杂志

基　　金：Supported by the Department of Health of Zhejiang Province,China,No.2016RCA013

摘　　要：BACKGROUND Severe hyponatremia is considered a rare complication of pituitrin,which is widely used for the treatment of pulmonary hemorrhage.However,the management of pituitrin-associated hyponatremia can be challenging because a rapid correction of hyponatremia may cause the development of osmotic demyelination syndrome,resulting in life-threatening neurological injuries.CASE SUMMARY A 20-year-old Chinese man with massive hemoptysis developed symptomatic hyponatremia(116 mmol/L)after therapy by a continuous intravenous drip of pituitrin.To normalize his serum sodium,a hypertonic saline infusion was applied for 3 d,and the pituitrin administration was stopped concurrently.Then,an overly rapid increase in serum sodium level(18 mmol/L in 24 h)was detected after treatment.One day later,the patient experienced a sudden onset of generalized tonic-clonic seizures,as well as subsequent dysarthria and dystonia.Magnetic resonance imaging revealed increased signal intensity in the bilateral symmetric basal ganglia on the T2-weighted images,compatible with a diagnosis of extrapontine myelinolysis.The patient received an intravenous administration of high-dose corticosteroids,rehabilitation,and neurotrophic therapy.Finally,his clinical abnormalities were vastly improved,and he was discharged with few residual symptoms.CONCLUSION Physicians should be fully aware that pituitrin can cause profound hyponatremia and its correction must be performed at a controlled rate to prevent the development of osmotic demyelination syndrome.BACKGROUND Severe hyponatremia is considered a rare complication of pituitrin, which is widely used for the treatment of pulmonary hemorrhage. However, the management of pituitrin-associated hyponatremia can be challenging because a rapid correction of hyponatremia may cause the development of osmotic demyelination syndrome, resulting in life-threatening neurological injuries.CASE SUMMARY A 20-year-old Chinese man with massive hemoptysis developed symptomatic hyponatremia(116 mmol/L) after therapy by a continuous intravenous drip of pituitrin. To normalize his serum sodium, a hypertonic saline infusion was applied for 3 d, and the pituitrin administration was stopped concurrently. Then,an overly rapid increase in serum sodium level(18 mmol/L in 24 h) was detected after treatment. One day later, the patient experienced a sudden onset of generalized tonic-clonic seizures, as well as subsequent dysarthria and dystonia.Magnetic resonance imaging revealed increased signal intensity in the bilateral symmetric basal ganglia on the T2-weighted images, compatible with a diagnosis of extrapontine myelinolysis. The patient received an intravenous administration of high-dose corticosteroids, rehabilitation, and neurotrophic therapy. Finally, his clinical abnormalities were vastly improved, and he was discharged with few residual symptoms.CONCLUSION Physicians should be fully aware that pituitrin can cause profound hyponatremia and its correction must be performed at a controlled rate to prevent the development of osmotic demyelination syndrome.

关 键 词：PITUITRIN HYPONATREMIA Extrapontine myelinolysis Case report 

分 类 号：R584[医药卫生—内分泌]