횡문근융해증이 합병된 중증 저나트륨혈증 환자에서 발생한 삼투성 탈수초 증후군 1예
A Case of Osmotic Demyelination Syndrome in a Patient with Severe Hyponatremia Complicated by Rhabdomyolysis
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Hyponatremia, the most common electrolyte disorder, has been rarely reported as causing rhabdomyolysis. Osmotic demyelination syndrome (ODS), a demyelinating disease of the central pons and/or other areas of the brain, is infrequently reported as associated with rapid correction of hyponatremia. This paper reports a case of ODS after correction of severe hyponatremia complicated by rhabdomyolysis. A 47-year-old female with a history of chronic alcoholism presented herself at the hospital with altered consciousness after three days of nausea and vomiting. She was on a thiazide diuretic for essential hypertension. Her blood tests upon her hospital admission showed hyponatremia (Na+ 98 mEq/L), hypokalemia (K+ 3.0 mEq/L), and elevation of her serum creatine phosphokinase (3,370 IU/L) with an increase in her serum myoglobin level 11,267 ng/mL). She was treated with intravenous fluid therapy that included isotonic and hypertonic salines along with potassium chloride. She became more alert, and her neurological condition gradually improved after the first five days of her therapy. On the ninth day after her admission, she developed progressive quadiaresis associated with dysarthria, dysphagia, and dystonia despite the resolution of her hyponatremia. Magnetic resonance imaging of her brain on 16th day revealed symmetrical areas of signal hyperintensity in her central pons, basal ganglia, and precentral gyrus in T2-weighted images, which are consistent with ODS. Her neurological symptoms steadily improved after six weeks with only supportive treatment and rehabilitation.
Abstract
Hyponatremia, the most common electrolyte disorder, has been rarely reported as causing rhabdomyolysis. Osmotic demyelination syndrome (ODS), a demyelinating disease of the central pons and/or other areas of the brain, is infrequently reported as associated with rapid correction of hyponatremia. This paper reports a case of ODS after correction of severe hyponatremia complicated by rhabdomyolysis. A 47-year-old female with a history of chronic alcoholism presented herself at the hospital with altered consciousness after three days of nausea and vomiting. She was on a thiazide diuretic for essential hypertension. Her blood tests upon her hospital admission showed hyponatremia (Na+ 98 mEq/L), hypokalemia (K+ 3.0 mEq/L), and elevation of her serum creatine phosphokinase (3,370 IU/L) with an increase in her serum myoglobin level 11,267 ng/mL). She was treated with intravenous fluid therapy that included isotonic and hypertonic salines along with potassium chloride. She became more alert, and her neurological condition gradually improved after the first five days of her therapy. On the ninth day after her admission, she developed progressive quadiaresis associated with dysarthria, dysphagia, and dystonia despite the resolution of her hyponatremia. Magnetic resonance imaging of her brain on 16th day revealed symmetrical areas of signal hyperintensity in her central pons, basal ganglia, and precentral gyrus in T2-weighted images, which are consistent with ODS. Her neurological symptoms steadily improved after six weeks with only supportive treatment and rehabilitation.
참고문헌 (18)
- Adrogué HJ, "Hyponatremia", N Engl J Med, 342, pp.1581~1589 (2000)
- Trimarchi H, "Hyponatremia-associated rhabdomyolysis", Nephron, 82, pp.274~277 (1999)
- Jun DW, "Hyponatremia in schizophrenia after water intoxification: a potential cause of rhabdomyolysis", Korean J Med, 59, pp.335~338 (2000)
- 이경욱, "저나트륨혈증과 동반된 횡문근융해증 1예", Endocrinology and Metabolism, 18(3), pp.306~310 (2003), 대한내분비학회
- 정성훈, "클로자핀(Clozapine)과 네모나프라이드(Nemonapride) 치료 중 나타난 저나트륨혈증과 횡문근융해 1예: 증례보고", 대한정신약물학회지, 17(4), pp.396~401 (2006), 대한정신약물학회
- 정재혁, "벤조디아제핀 복용 중 발생한 저나트륨혈증에 의한 횡문근융해증 1예", 대한내과학회지, 75(6), pp.718~722 (2008), 대한내과학회
- Lampl C, "Central pontine myelinolysis", Eur Neurol, 47, pp.3~10 (2002)
- 김은영, "만성 저나트륨혈증의 빠른 교정 후 발생한 삼투성 탈수초증후군에서 신경학적으로 완전한 회복을 보인 2예", Kidney Research and Clinical Practice, 26(3), pp.342~347 (2007), 대한신장학회
- Spital A, "Diuretic-induced hyponatremia", Am J Nephrol, 19, pp.447~452 (1999)
- Berl T, "A patient with severe hyponatremia and hypokalemia: osmotic demyelination following potassium repletion", Am J Kidney Dis, 55, pp.742~748 (2010)
- Bosch X, "Rhabdomyolysis and acute kidney injury", N Engl J Med, 361, pp.62~72 (2009)
- DiBona FJ, "Rhabdomyolysis associated with influenza A. report of a case with unusual fluid and electrolyte abnormalities", J Pediatr, 91, pp.943~945 (1977)
- Korzets A, "Severe hyponatremia after water intoxication: a potential cause of rhabdomyolysis", Am J Med Sci, 312, pp.92~94 (1996)
- Khan FY, "Rhabdomyolysis: a review of the literature", Neth J Med, 67, pp.272~283 (2009)
- Martin RJ, "Central pontine and extrapontine myelinolysis:the osmotic demyelination syndromes", J Neurol Neurosurg Psychiatry, 75(3), pp.iii22~iii28 (2004)
- Brown WD, "Osmotic demyelination disorders: central pontine and extrapontine myelinolysis", Curr Opin Neurol, 13, pp.691~697 (2000)
- Chua GC, "MRI findings in osmotic myelinolysis", Clin Radiol, 57, pp.800~806 (2002)
- Menger H, "Outcome of central pontine and extrapontine myelinolysis (n=44)", J Neurol, 246, pp.700~705 (1999)