Myelinolysis and rhabdomyolysis in a child with severe hypernatremia

Abstract

Osmotic demyelination syndrome, also known as central pontine myelinolysis, was first described in 1959, being associated with rapid and / or incorrect correction of hyponatremia in the body. Demyelination can also be observed in severe hypernatremia, both as a result of improper correction and in exogenous sodium intake of various natures, and the areas of damage may be extrapontinous. Isolated cases of cerebral myelinolysis due to exogenous abnormal sodium intake have been reported in the literature, mainly due to nutritional errors. We present a case of a 15-year-old girl who, due to a dietary error, reached an extreme intake of sodium, with a significant restriction of fluid and food intake, probably in the field of undiagnosed eating disorder. The girl presents with significant cognitive impairment, severe confusion, significant deviations in a number of laboratory parameters – hypernatremia over 180 mmol/l, elevated urea, creatinine, ASАT, ALАT, extreme increase in CPK to over 79,000 U/l, with severe ataxia and MRI data for extrapontinе myelinolysis.