Central pontine myelinosis after treatment of hyponatremia with tolvaptan: a case report

Abstract

Background: Central pontine myelinosis (CPM) is a demyelinating disorder affecting the pontine white matter. Predisposing conditions include alcoholism, liver disease, malnutrition, and hyponatremia. The purpose of this case report is to highlight the importance of early identification of CPM in patients with hyponatremia undergoing rapid sodium correction.
Case: A 42-year-old male with cirrhosis and refractory ascites with malnutrition was admitted with chronic hypervolemic hyponatremia. He developed acute hypernatremia and osmotic demyelination syndrome due to administration of tolvaptan. We raise the question of optimal dosing of vasopressin antagonists by frequent daily evaluation of sodium levels.
Conclusion: Early diagnosis based on clinical symptoms and timely management decreases morbidity and mortality in patients with liver diseases exhibiting chronic hyponatremia.