Osmotic demyelination syndrome secondary to correction of metabolic acidosis with sodium bicarbonate. Case report

Vasquez-Kunze S.; Arrunátegui Bermejo C.; Villaverde Pelaez H. · Revista Medica Herediana (2025) · DOI: 10.20453/rmh.v36i3.6155

Resumen

Osmotic demyelination syndrome (ODS) is a neurological complication that occurs due to the rapid correction of hyponatremia. This case involves a 79-yearold woman with hyporexia and constipation lasting four weeks. Upon admission, she was dehydrated and had a Glasgow scale score of 14. Her tests showed Na 121 mEq/L, creatinine 5.86 mg/dl, pH 7.24, pCO2 8.2 mm Hg, and HCO3 6.8 mmol/l. She was administered 0.9% NaCl at 120 ml/h and 8.4% sodium bicarbonate, 21 vials of 20 ml over 24 hours. After 24 hours, her creatinine decreased to 3.6 mg/dl, and her serum sodium was 144 mEq/l. Due to persistent altered sensorium, a brain MRI was performed, revealing mesencephalic lesions characteristic of osmotic demyelination syndrome. She was discharged with physical therapy. It is concluded that using sodium bicarbonate to correct metabolic acidosis can provoke a rapid increase in plasma sodium and lead to ODS. Corrections of metabolic acidosis in patients with concomitant hyponatremia should be performed carefully. © Los autores.

Instituciones: Universidad Peruana Cayetano Heredia