Figure 1.
Osmotic demyelination syndrome in reported cases despite changes in serum sodium (SNa) that adhere to current hyponatremia correction guidelines. Open squares represent patients with initial SNa <115 mEq/L. Closed triangles represent patients with initial SNa ≥115 mEq/L. The dashed lines represent therapeutic limits recommended by current hyponatremia guidelines (12 mEq/L in 24 hours and 18 mEq/L in 48 hours). The case from Koul et al. (29) is not represented in this figure because changes in SNa at 24 and 48 hours were not reported. Two patients with initial SNa <115 mEq/L (John et al. [8] and Malhotra et al. [35]) corrected their SNa by 8 mEq/L and 16 mEq/L at 24 and 48 hours, respectively.