REPLY
Hyponatremia and Myelinolysis
Barbara I. Karp, MD, and
Robert Laureno, MD
15 July 1997 | Volume 127 Issue 2 | Page 163
IN RESPONSE:
Rapid correction of hyponatremia can cause myelinolysis. This iatrogenic illness has been well documented in humans [1, 2] and in controlled experiments in three mammalian species [3-5].
Drs. Ayus and Arieff state that the rate of correction of plasma sodium concentration is "irrelevant," yet they warn that a rate of correction of "more than 25 mmol/L in 48 hours can lead to cerebral demyelinating lesions." These statements are contradictory. The authors then discuss one possible outcome of symptomatic hyponatremia. We have always recognized that neurologic complications are associated with both hyponatremia and its correction. We hope that Drs. Ayus and Arieff will soon recognize the amassed data showing that rapid correction of hyponatremia may cause myelinolysis.
We advise that the increase in serum sodium concentration be limited, whenever possible, to a rate of less than 10 mmol/L in any 24-hour period.
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Author and Article Information
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National Institutes of Health; Bethesda, MD 20892
Washington Hospital Center; Washington, DC 20010
1. Karp BP, Laureno R. Pontine and extrapontine myelinolysis. A neurological disorder following rapid correction of hyponatremia. Medicine (Baltimore). 1993; 72:359-73.
2. Sterns RH, Cappuccio JD, Silver SM, Cohen EP. Neurological sequelae after treatment of severe hyponatremia: a multicenter perspective. J Am Soc Nephrol. 1994; 4:1522-30.
3. Illowsky BP, Laureno R. Encephalopathy and myelinolysis after rapid correction of hyponatremia. Brain. 1987; 110:855-67.
4. Laureno R. Central pontine myelinolysis following rapid correction of hyponatremia. Ann Neurol. 1983; 13:232-42.
5. Verbalis J, Martinez AJ. Neurological and neuropathological sequelae of correction of chronic hyponatremia. Kidney Int. 1991; 39:1274-82.
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