Table 2.
Patients with initial serum sodium ≥115 mEq/L who experienced osmotic demyelination syndrome
| Reference | Age/Sex | Initial SNa (mEq/L) | Factors Increasing Risk of ODS | ΔSNa at 24 h (mEq/L) | ΔSNa at 48 h (mEq/L) | Maximum ΔSNa (mEq/L per day) | ODS Symptoms (Onset) | Brain MRI | Final Outcome |
| Hu et al. (23) | 30/M | 115 | High ammonia levels | 5 | 9 | 5 | Dysarthria, dysphagia, exaggerated deep tendon reflexes (day 2) |
EPM | No improvement |
| Pradhan et al. (17) | 55/M | 115 | Malnutrition | 3 | 7 | 4 | Spastic quadriparesis, brisk deep tendon reflexes, positive Babinski in right (day 8) |
CPM | No improvement, patient death |
| Macmillan et al. (4) | 60–64/M | 115 | Alcohol use disorder; liver disease; malnutrition | 7 | 6 | 7 | Symptoms not described by authors (day 12) |
Areas of lesions not specified | Unknown residual deficits |
| Pradhan et al. (17) | 39/M | 118 | Malnutrition | 4 | 8 | 4 | Dysarthria, dysphagia, rigidity, impaired horizontal eye movement, decorticate posturing, brisk deep tendon reflexes, positive Babinski bilaterally (day 6) |
CPM and EPM | Incomplete recovery. Able to feed himself, speak few words, walk with support. Cogwheel rigidity and parkinsonian gait persisted |
| Zunga et al. (16) | 65/F | 121 | Hypokalemia | 6 | 12 | 6 | Altered sensorium, stuporous (on admission) |
EPM | Full recovery |
| Orakzai et al. (38) | 52/M | 122 | Alcohol use disorder; malnutrition | 8 | 16 | 8 | Nonverbal, decreased right hand grip strength, paralysis of other extremities, Babinski positive bilaterally, pupillary responses sluggish (day 5) |
CPM | Complete resolution |
| Jahan et al. (39) | 55/M | 123 | Alcohol use disorder; malnutrition | 5 | 5 | 5 | Encephalopathic, dysarthria, dysphagia, ophthalmoplegia, brisk deep tendon reflexes in all extremities (day 7) |
CPM and EPM | Dysarthria, dysphagia, neurologic exam improved “significantly” |
| Davenport et al. (21) | 63/M | 127 | Alcohol use disorder; hypokalemia; malnutrition | 9 | 15 | 10 (SNa 161 on day 7) |
Obtundation, comatose (day ?) |
CPM | Death |
| Shah et al. (3) | 26/M | 130 | Alcohol use disorder; liver disease; malnutrition |
2 | 6 | 4 | Never developed ODS symptoms | CPM (MRI done to evaluate lymphoma) | Remained asymptomatic |
SNa, serum sodium concentration; ODS, osmotic demyelination syndrome; ΔSNa, change in SNa; MRI, magnetic resonance imaging; M, male; EPM, extrapontine myelinolysis; CPM, central pontine myelinolysis; F, female.