Published online Mar 6, 2020. doi: 10.12998/wjcc.v8.i5.946
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
Processing time: 97 Days and 17.9 Hours
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.
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.
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.
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.