From the Guidelines
Osmotic demyelination syndrome (ODS) typically presents with symptoms such as seizure, encephalopathy, dysarthria, dysphagia, oculomotor dysfunction, and quadriparesis, usually 2 to 7 days after rapid correction of serum sodium levels. The symptoms of ODS can vary in severity and may include:
- Seizure or encephalopathy as initial presentations
- Short-term improvement followed by clinical deterioration
- Dysarthria (difficulty speaking)
- Dysphagia (difficulty swallowing)
- Oculomotor dysfunction (problems with eye movements)
- Quadriparesis (weakness in all four limbs) These symptoms can be diagnosed through physical examination and brain magnetic resonance imaging 1. The risk of developing ODS is higher in patients with advanced liver disease, alcoholism, severe hyponatremia, malnutrition, and certain metabolic derangements, such as hypophosphatemia, hypokalemia, or hypoglycemia 1. To mitigate the risk of ODS, it is recommended to correct serum sodium levels slowly, with a goal rate of change of 4-8 mEq/L per day, not to exceed 10-12 mEq in a 24-hour period, and even slower in patients at high risk of ODS 1.
From the Research
Symptoms of Osmotic Demyelination Syndrome
The symptoms of Osmotic Demyelination Syndrome (ODS) can vary, but some common symptoms include:
- Confusion and lethargy 2
- Loss of consciousness 2
- Seizures and status epilepticus 2
- Dermatological manifestations, such as blistering lesions and facial edema 2
- Gait disturbances 2
- Hyperintense lesions in the median portion of the pons on T2-fluid-attenuated inversion recovery (FLAIR) MRI sequence 2
- Irreversible coma 2
Risk Factors for Osmotic Demyelination Syndrome
Some risk factors for ODS include:
- Rapid overcorrection of severe chronic hyponatremia 3, 4, 5, 6
- Serum sodium <115 mEq/L 4
- Alcohol use disorder 4
- Hypokalemia 4
- Liver disease 4
- Malnutrition 4
- Community-acquired chronic hyponatremia 4
Prognosis of Osmotic Demyelination Syndrome
The prognosis of ODS is generally poor, with high mortality rates and significant risks, particularly following the rapid correction of severe hyponatremia 2, 5, 6. However, some patients may make a full recovery with aggressive therapy and long-term care 3.