As we know that a complication of overcorrection of
hyponatremia is central pontine myelinolysis(CPM). Once it happens, what can be done to improve the neurological complications?
A recent case
report shines light into an older treatment approach from 1990s- plasma exchange. In this case report, a patient received IV bicarbonate therapy for distal RTA
from sjorgen’s syndrome and Na corrected from 140s to 170s in 24 hours and then
few days later leads to CPM .
Two days of 4+ liters of plasma exchange were done with
albumin and FFP replacement. Two days following the treatment, the neurological
symptoms improved. The sodium level also
was getting staying stable.
So how does one treat CPM? – besides preventive
strategies
There have been some animal studies investigating the benefits of
re-inducing hyponatremia in the case of rapid overcorrection of hyponatremia in order to
avoid osmotic demyelination. So bring the Na back down again to allow for the
change to be mitigated. What about
plasma exchange? This was first attempted in 1999 Lancet paper that showed that 3 patients were successfully treated with plasma
exchange ( but in those cases were for weeks compared to the above case for
only 2 sessions)
Another case report exists in use of this strategy in a liver transplant patient with CPM.
One more in the neurology literature adds to this potential treatment.
Myelin toxic
compounds may be removed by plasma exchange due to their high molecular weight
and preventing the further damage is the suggested mechanism.
Would it be worth doing plasma exchange while correcting for
hyponatremia simultaneously in high risk patients? – such as the alcoholic beer
potemanias? Some food for thought.
Image source: wikipedia.com
