scholarly journals Role of Risk Factors in Developing Osmotic Demyelination Syndrome During Correction of Hyponatremia: A Case Study

Cureus ◽  
2020 ◽  
Author(s):  
Tom D.Y. Reijnders ◽  
Wilbert M.T. Janssen ◽  
S.M. Laila Niamut ◽  
Andrea B Kramer
Keyword(s):  
Risk Factors ◽  
Osmotic Demyelination Syndrome ◽  
Osmotic Demyelination

scholarly journals Osmotic Demyelination: From an Oligodendrocyte to an Astrocyte Perspective

2019 ◽  
Vol 20 (5) ◽  
pp. 1124 ◽  
Author(s):  
Charles Nicaise ◽  
Catherine Marneffe ◽  
Joanna Bouchat ◽  
Jacques Gilloteaux
Keyword(s):  
Glial Cells ◽  
Serum Sodium ◽  
Brain Regions ◽  
Osmotic Demyelination Syndrome ◽  
Brain Areas ◽  
Osmotic Demyelination ◽  
Central Myelin ◽  
Barrier Breakdown ◽  
Blood Brain Barrier Breakdown

Osmotic demyelination syndrome (ODS) is a disorder of the central myelin that is often associated with a precipitous rise of serum sodium. Remarkably, while the myelin and oligodendrocytes of specific brain areas degenerate during the disease, neighboring neurons and axons appear unspoiled, and neuroinflammation appears only once demyelination is well established. In addition to blood‒brain barrier breakdown and microglia activation, astrocyte death is among one of the earliest events during ODS pathology. This review will focus on various aspects of biochemical, molecular and cellular aspects of oligodendrocyte and astrocyte changes in ODS-susceptible brain regions, with an emphasis on the crosstalk between those two glial cells. Emerging evidence pointing to the initiating role of astrocytes in region-specific degeneration are discussed.

scholarly journals Osmotic Demyelination Syndrome Following Correction of Hyponatremia by ≤10 mEq/L per day

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0004402021
Author(s):  
Srijan Tandukar ◽  
Richard H. Sterns ◽  
Helbert Rondon-Berrios
Keyword(s):  
Risk Factors ◽  
Serum Sodium ◽  
Alcohol Use Disorder ◽  
Neurological Deficits ◽  
Osmotic Demyelination Syndrome ◽  
European Guidelines ◽  
Osmotic Demyelination ◽  
Chronic Hyponatremia ◽  
The Mean ◽  
Sodium Correction

Background: Overly rapid correction of chronic hyponatremia may lead to osmotic demyelination syndrome. European guidelines recommend a correction to ≤10 mEq/L in 24 hours to prevent this complication. However, osmotic demyelination syndrome may occur despite adherence to these guidelines. Methods: We searched the literature for reports of osmotic demyelination syndrome with rates of correction of hyponatremia <10 mEq/L in 24 hours. The reports were reviewed to identify specific risk factors for this complication. Results: We identified 19 publications with a total of 21 patients that were included in our analysis. The mean age was 52 years of which 67% were male. All of the patients had community acquired chronic hyponatremia. Twelve patients had an initial serum sodium <115 mEq/L, of which seven had an initial serum sodium ≤105 mEq/L. Other risk factors identified included alcohol use disorder (n=11), hypokalemia (n=5), liver disease (n=6), and malnutrition (n=11). The maximum rate of correction in patients with serum sodium <115 mEq/L was at least 8 mEq/L in all but 1 patient. In contrast, correction was <8 mEq/L in all but 2 patients with serum sodium >115 mEq/L. Among the latter group, osmotic demyelination syndrome developed before hospital admission or was unrelated to hyponatremia overcorrection. Four patients died (19%), 5 had full recovery (24%) and 9 (42%) had varying degrees of residual neurological deficits. Conclusions: Osmotic demyelination syndrome can occur in patients with chronic hyponatremia with a serum sodium <115 mEq/L despite rates of serum sodium correction <10 mEq/L in 24 hours. In patients with severe hyponatremia and high risk features, especially those with serum sodium <115 mEq/L, we recommend limiting serum sodium correction to <8 mEq/L. Thiamine supplementation is advisable for any hyponatremic patient whose dietary intake has been poor.

scholarly journals Protecting the organization against risk and the role of financial audit on the example of the internal audit

2016 ◽  
Vol 7 (3) ◽  
pp. 485 ◽  
Author(s):  
Sylwia Bożek ◽  
Izabela Emerling
Keyword(s):  
Risk Factors ◽  
Research Methods ◽  
Conceptual Analysis ◽  
Applied Research ◽  
Internal Audit ◽  
Financial Audit ◽  
Economic Reality ◽  
Effectiveness And Efficiency

In the contemporary economic reality and organization’s activities aiming at effectiveness and efficiency of functioning, a lot of significance is attached to a financial audit as an important instrument for protecting the organization against the risk factors. The aim of this article is to present theoretical and practical (on the basis of the examined example) aspects concerning the (internal) financial audit in the organization within the context of its assessment of the exposure to risk. The applied research methods are based on the method of conceptual analysis of the literature on the examined field, as well as on the case study of the auditing task. The results of the performed analyses and examinations allow to state that the financial audit constitutes an effective tool for protecting the organization against internal, as well as external risks.

scholarly journals Osmotic Demyelination Syndrome in a Patient with Hypokalemia but No Hyponatremia

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Carolina Ormonde ◽  
Raquel Cabral ◽  
Sara Serpa
Keyword(s):  
Risk Factors ◽  
Central Nervous System ◽  
Nervous System ◽  
Rare Case ◽  
Rapid Rise ◽  
Osmotic Demyelination Syndrome ◽  
Multiple Risk Factors ◽  
Osmotic Demyelination ◽  
The Central Nervous System ◽  
Rapid Correction

Osmotic demyelination syndrome (ODS) is characterized by loss of myelin in various parts of the central nervous system. It is mainly caused by a rapid correction of hyponatremia, although other factors that may cause rapid rise in serum osmolality can also be associated with its development. Its prognosis is poor and the recovery rate is unknown. The authors report a rare case of a patient with multiple risk factors for ODS, without hyponatremia, who developed ODS and surprisingly recovered. This case report highlights the importance of recognizing risk factors for the development of ODS, even if the main one is not present.

scholarly journals A case of Osmotic demyelination syndrome despite normal rate of Sodium correction with good recovery

2018 ◽  
Vol 17 (3) ◽  
pp. 160-163
Author(s):  
Shiva Mongolu ◽  
Keyword(s):  
Risk Factors ◽  
Sodium Concentration ◽  
Good Recovery ◽  
Osmotic Demyelination Syndrome ◽  
Good Clinical Outcome ◽  
Osmotic Demyelination ◽  
Severe Hyponatraemia ◽  
Sodium Correction ◽  
Hospital Inpatients ◽  
Rapid Correction

The Osmotic demyelination syndrome (ODS) primarily occurs with rapid correction of severe hyponatraemia that has been present for more than two or three days. Some patients are, however at risk and can develop ODS at higher sodium concentration and lower rates of correction. A case of Osmotic demyelination Syndrome which developed despite an ‘optimal’ rate of correction of serum Sodium with good clinical outcome is described. The risk factors that contribute to development of ODS and strategies to prevent this complication are discussed, along with recommendations on how to manage this condition in hospital inpatients.

scholarly journals Osmotic demyelination syndrome following slow correction of hyponatremia: Possible role of hypokalemia

2013 ◽  
Vol 17 (4) ◽  
pp. 231-233 ◽  
Author(s):  
Mohammed Ashraf ◽  
Parvaiz A. Koul ◽  
Umar Hafiz Khan ◽  
Rafi A. Jan ◽  
Sanaullah Shah ◽  
...  
Keyword(s):  
Osmotic Demyelination Syndrome ◽  
Osmotic Demyelination

scholarly journals Unpredictable Nature of Tolvaptan in Treatment of Hypervolemic Hyponatremia: Case Review on Role of Vaptans

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Ishan Malhotra ◽  
Shilpa Gopinath ◽  
Kalyana C. Janga ◽  
Sheldon Greenberg ◽  
Shree K. Sharma ◽  
...  
Keyword(s):  
Volume Status ◽  
Case Review ◽  
Osmotic Demyelination Syndrome ◽  
Sodium Deficiency ◽  
Neurologic Recovery ◽  
Vasopressin Antagonists ◽  
Low Sodium ◽  
Osmotic Demyelination ◽  
Sodium Correction

Hyponatremia is one of the most commonly encountered electrolyte abnormalities occurring in up to 22% of hospitalized patients. Hyponatremia usually reflects excess water retention relative to sodium rather than sodium deficiency. Volume status and serum osmolality are essential to determine etiology. Treatment depends on several factors, including the cause, overall volume status of the patient, severity of hyponatremic symptoms, and duration of hyponatremia at presentation. Vasopressin antagonists like tolvaptan seem promising for the treatment of euvolemic and hypervolemic hyponatremia in heart failure. Low sodium concentrations cause cerebral edema, but the overly rapid sodium correction can also lead to iatrogenic cerebral osmotic demyelination syndrome. Demyelination may occur days after sodium correction or initial neurologic recovery from hyponatremia. The following case report analyzes the role of vasopressin antagonists in the treatment of hyponatremia and the need for daily dosing of tolvaptan and the monitoring of serum sodium levels to avoid rapid overcorrection which can result in osmotic demyelination syndrome (ODS).

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