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Central Nervous System Complications of Severe Hyponatremia

  • Richard H. Sterns

Abstract

The brain has an astonishing ability to adapt to osmotic disturbances: survival has been recorded at serum sodium concentrations ranging from 85 to 272 mmol/1 (1). However, because this adaptation takes time, the brain does not take well to abrupt changes (1–3). A sudden onset of severe hypernatremia dehydrates the brain, shrinking it away from its vascular attachments and causing fatal cerebral hemorrhage (4). An acute onset of severe hyponatremia causes cerebral edema, swelling the brain beyond the capacity of the cranial vault and causing fatal herniation (5). Once the brain has adapted to an abnormal osmotic environment, rapid correction of the disturbance may also be injurious. We have long known that overenthusiastic rehydration of patients with chronic hypernatremia may result in cerebral edema and seizures (4). More recently it has been shown that excessively aggressive correction of chronic hyponatremia may cause delayed neurologic deterioration and brain demyelination — a phenomenon that has been dubbed the “osmotic demyelination syndrome”(1–3,6–9).

Keywords

Cerebral Edema Serum Sodium Concentration Central PONTINE MYELINOLYSIS Water Intoxication Rapid Correction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag London Limited 1991

Authors and Affiliations

  • Richard H. Sterns
    • 1
  1. 1.Division of Nephrology, Department of MedicineUniversity of Rochester School of Medicine, Rochester General HospitalRochesterUSA

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