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Case Reports
Osmotic Demyelination Syndrome in a Patient with Diabetic Ketoacidosis Despite No Rapid Sodium Correction.
- Toshiyuki Nakanishi, Satoko Tamaru, Taku Harada, Kenta Shukuya, Kazushi Yamasato, Jun Kataoka, Kohzoh Makita, and Mori Nakai.
- Department of General Medicine, Nerima Hikarigaoka Hospital, Japan.
- Intern. Med. 2024 Jun 1; 63 (11): 159115961591-1596.
AbstractOsmotic demyelination syndrome (ODS) occurs in patients with diabetes and hyponatremia. We herein report a case of ODS with chorea detected on serial magnetic resonance imaging (MRI), despite no prompt hyponatremia correction. A 74-year-old man with cirrhosis and uncontrolled type 2 diabetes developed an altered mental status and chorea during treatment for diabetic ketoacidosis (DKA). Despite no rapid sodium correction and normal initial brain MRI findings, serial MRI revealed ODS-related abnormalities. Clinicians should consider ODS in patients with DKA and a hyperosmolar hyperglycemic state displaying unconsciousness and neurological manifestations, including chorea, even without substantial changes in serum sodium levels. An MRI re-examination can help capture missing ODS complications.
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