Extrapontine myelinolysis caused by rapid correction of pituitrin-induced severe hyponatremia: A case report

Table 1 Trends of the patient's clinical and laboratory data

Day	Serum K+ (mmol/L)	Serum Na+ (mmol/L)	Serum osmolality (mOsm/kg)	1.5% NaCl (mL)	Urine output (L)
1	4.12	140	298	_	2.1
2	4.10	132	284	_	1.8
3	3.63	116	248	500	1.6
4	3.29	113	240	750	1.1
5	3.35	119	251	750	0.9
6	4.07	137	288	_	2.1
7	3.80	141	299	_	2.2
8	4.52	137	292	_	1.6

Serum osmolality = 2 (Na⁺ + K⁺) + Glucose (mmol/L) + Blood urea nitrogen (mmol/L).

Table 2 Clinical characteristics of central pontine myelinolysis and/or extrapontine myelinolysis associated with vasopressin or its analogs

Ref.	Age/sex	Drug	Original disease	Treatment of hypona-tremia	Hypona-tremia improve-ment (mmol/L)	Lesions	Neuro-logical presentation	Therapy for ODS	Outcome
Niehaus et al[15], 2001	16/F	Antidiuretic hormone	Nocturnal enuresis	Discontinued drug + hypertonic saline	10 in 24 h (128 to 138)	EPM, CPM	Conscious disturbance	Prednisolone	Recovery
Gutenstein[16], 2007	39/F	Desmopressin	Hypopituitary	Saline	38 in 48 h (103 to 141)	EPM, CPM	Dysarthria, hemiplegia, seizures	NA	Death
Ranger et al[17], 2010	13/M	Desmopressin	Central DI	NA	60 in 48 h (116 to 176)	EPM, CPM	Coma	NA	Death
Solà et al[18], 2010	NA	Terlipressin	Gastrointestinal bleeding	Discontinued drug + hypertonic saline	19 in 24 h (109 to 128)	ODS,	Seizures, coma	NA	Recovery
Zhuang et al[19], 2014	24/F	Pituitrin	Hemoptysis	Discontinued drug + hypertonic saline	16 in 24 h (118 to 134)	EPM	Dysarthria, quadriparesis, dystonia	Corticosteroid	Recovery
Nabaei et al[20], 2015	23/F	Desmopressin	Central DI	Discontinued drug + hypertonic saline	40 in 24 h (126 to166)	EPM, CPM	Quadriparesis, dysarthria, dysphagia	NA	Severe brain damage
Hossain et al[21], 2018	69/M	Desmopressin	Central DI	Discontinued drug + hypertonic saline	Less than 8 in 24 h	CPM	NA	NA	Recovery

DI: Diabetes insipidus; M: Male; F: Female; NA: Not available; CPM: Central pontine myelinolysis; EPM: Extrapontine myelinolysis; ODS: Osmotic demyelination syndrome.