• Shih-Hua Lin, Tom Chau, Chia-Chao Wu, and Sung-Sen Yang.
• Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China. l521116@ndmctsgh.edu.tw
• Am. J. Med. Sci. 2002 May 1; 323 (5): 259-62.

AbstractRapid correction of severe chronic hyponatremia with hypertonic saline has been known to cause osmotic demyelination syndrome (ODS). Less recognized are the dangers of rapid correction with normal saline. A 60-year-old woman on thiazide diuretics for hypertension presented with profound hyponatremia (94 mmol/L) and hypokalemia (1.9 mmol/L) associated with volume depletion. Normal saline (2 L/day) and (KCl 40 mmol/day) were given for 5 days. Serum Na+ concentration rose to 106 mmol/L within 18 hours. With improvement of her hyponatremia, she became more alert although the hypokalemia persisted. However, she developed progressive obtundation, quadriplegia, and respiratory failure 6 days later. Magnetic resonance imaging of the brain clearly showed typical features of pontine and extrapontine myelinolysis. We suggest that the aggressive KCl supplement would have been the first-line therapy for this patient presenting with chronic hyponatremia and hypokalemia associated with volume depletion.

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