Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2020; 8(5): 946-953
Published online Mar 6, 2020. doi: 10.12998/wjcc.v8.i5.946
Extrapontine myelinolysis caused by rapid correction of pituitrin-induced severe hyponatremia: A case report
Liang-Jie Fang, Ming-Wei Xu, Jian-Ying Zhou, Zhi-Jie Pan
Liang-Jie Fang, Jian-Ying Zhou, Zhi-Jie Pan, Department of Respiratory Medicine, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
Ming-Wei Xu, Department of Neurology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
Author contributions: Fang LJ collected the case data and drafted the article; Fang LJ and Xu MW consulted literature material; Zhou JY and Pan ZJ revised the manuscript; all authors read and approved the final manuscript.
Supported by the Department of Health of Zhejiang Province, China, No. 2016RCA013.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zhi-Jie Pan, MD, Chief Doctor, Professor, Department of Respiratory Medicine, First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou 310009, Zhejiang Province, China. panzj200709@zju.edu.cn
Received: November 29, 2019
Peer-review started: November 29, 2019
First decision: December 30, 2019
Revised: January 6, 2020
Accepted: February 12, 2020
Article in press: February 12, 2020
Published online: March 6, 2020
Abstract
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.

Keywords: Pituitrin, Hyponatremia, Extrapontine myelinolysis, Case report

Core tip: Osmotic demyelination syndrome (ODS) is a devastating neurologic disorder often associated with a precipitous rise in serum sodium. Here we describe a rare case of extrapontine myelinolysis that developed after a rapid correction of symptomatic hyponatremia induced by pituitrin to treat a patient with massive hemoptysis. Because ODS is mainly an iatrogenic disease, effective prevention is mandatory. Through an analysis of the previous literature, the risk factors, clinical characteristics, and outcomes of vasopressin (pituitrin)-associated ODS are discussed in this article.