From the Guidelines
To prevent myelinolysis, sodium correction should be limited to 6-8 mEq/L per 24 hours in high-risk patients, such as those with severe hyponatraemia, as rapid correction can lead to central pontine myelinolysis, as highlighted in the management of autoimmune encephalitis patients 1. When managing patients with severe hyponatraemia, it is crucial to avoid rapid correction of sodium levels to prevent myelinolysis.
- Controlled slow correction of sodium levels is essential in patients with severe hyponatraemia to avoid central pontine myelinolysis, as stated in the study on autoimmune encephalitis 1.
- In most cases, hyponatraemia is related to inappropriate antidiuretic hormone secretion, and fluid restriction is sufficient, as noted in the study 1.
- The study emphasizes the importance of careful monitoring and management of blood pressure and heart rate fluctuations in patients with severe dysautonomia, which can be associated with hyponatraemia and myelinolysis 1. Key considerations in preventing myelinolysis include:
- Identifying high-risk patients, such as those with chronic hyponatremia, alcoholism, malnutrition, or liver disease
- Limiting sodium correction to 6-8 mEq/L per 24 hours
- Using hypertonic saline for severe hyponatremia or fluid restriction for milder cases
- Frequent monitoring of serum sodium levels to avoid rapid changes in osmolality, as recommended in the context of autoimmune encephalitis management 1.
From the Research
Myelinolysis Overview
- Myelinolysis is a neurological disorder characterized by damage to the myelin and oligodendrocytes in the pons, often associated with rapid correction of hyponatremia 2.
- The condition can display diverse psychiatric symptoms, with electrolyte imbalance, alcoholism, and malnutrition being frequent causes 3.
Causes and Risk Factors
- Rapid correction of hyponatremia is a known cause of myelinolysis, with a recommended increase in plasma sodium concentration of no more than 8 to 10 mmol/L per 24 h in chronic hyponatremia 2.
- Severe hyponatremia correction rates are frequently limited in patients to prevent neurologic complications, but the implications of correction rates on overall mortality and length of hospital stay are unclear 4.
- Animal models have demonstrated the role of rapid correction of hyponatremia as causative of pontine and extrapontine myelinolytic lesions 5, 2.
Treatment and Prevention
- Myoinositol administration has been shown to improve survival and reduce myelinolysis after rapid correction of chronic hyponatremia in rats 6.
- Limiting the sodium correction rate has been associated with higher mortality and longer length of stay, highlighting the need for careful management of hyponatremia correction 4.
- Psychiatrists should be meticulous in excluding organic causes in first-episode mania and consider myelinolysis in the differential diagnosis for the pertinent patient group 3.