Neuropsychiatric Manifestations of Osmotic Demyelination Syndrome Secondary to Overcorrection of Severe Hyponatraemia in Hyperemesis Gravidarum: A Case Report

Osmotic demyelination syndrome (ODS) may occur as a consequence of a rapid change in serum osmolality. We report a case of a 32-year-old woman who presented to the hospital with symptoms suggestive of severe hyperemesis gravidarum. Blood investigation results showed that patient had severe hyponatraemia (serum sodium 109 mmol/L) and hypokalaemia (serum potassium 1.7 mmol/L). Active and vigorous corrections to these electrolyte imbalances had led to an overly increased of serum sodium levels within a short duration of time. Four days after the rapid correction, patient started exhibiting neuropsychiatric manifestations. Radiological findings were consistent with the diagnosis of ODS. The neuropsychiatric symptoms experienced by patient gradually worsened with time. Subsequently, intravenous methylprednisolone was administered to patient. Patient showed marked response to the steroid given. At the time of discharge, twenty-seven days later, patient had recovered from most of the neuropsychiatric sequelae; but still required assistance during ambulation. In conclusion, correction of electrolyte imbalances should be done in a more judicious manner. Prudent corrections of electrolyte alterations could have possibly prevented the onset of ODS and its’ devastating neuropsychiatric sequelae in this patient. Please click PDF below to download the full paper...