Central pontine myelinolysis medical therapy: Difference between revisions

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__NOTOC__
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{{Central pontine myelinolysis}}
{{Central pontine myelinolysi}}
{{CMG}}
{{CMG}}; {{AE}} {{MMJ}}
 
==Overview==
==Overview==
Treatment of patients with central pontine myelinolysis is mainly supportive because once the [[Osmotic demyelination syndrome|osmotic demyelination]] has begun, there is no cure or specific treatment. Alcoholic patients should receive vitamin supplementation including [[vitamin B6]], [[Vitamin B9|B9]], and [[Vitamin B12|B12]] and evaluation of their nutritional status.
==Medical Therapy==
==Medical Therapy==
To avoid myelinolysis, the correction of hyponatremia should not exceed 1 mEq/L per hour. <ref>Kleinschmidt-DeMasters BK, Norenberg MD. Rapid correction of hyponatremia causes demyelination: relation to central pontine myelinolysis. ''Science.'' 1981;211(4486):1068-70. PMID 7466381</ref><ref>Laureno R. Experimental pontine and extrapontine myelinolysis. ''Trans Am Neurol Assoc.'' 1980;105:354-8. PMID 7348981</ref>  There is no specific treatment and the syndrome is associated with high mortality and morbidity. This being a potentially avoidable disaster, following recommendations may be adhered to while maintaining sodium levels:
Treatment of patients with central pontine myelinolysis is mainly supportive because once the [[Osmotic demyelination syndrome|osmotic demyelination]] has begun, there is no cure or specific treatment.<ref name="pmid24569125">{{cite journal| author=Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D et al.| title=Clinical practice guideline on diagnosis and treatment of hyponatraemia. | journal=Eur J Endocrinol | year= 2014 | volume= 170 | issue= 3 | pages= G1-47 | pmid=24569125 | doi=10.1530/EJE-13-1020 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24569125  }}</ref><ref name="pmid11803185">{{cite journal| author=Lampl C, Yazdi K| title=Central pontine myelinolysis. | journal=Eur Neurol | year= 2002 | volume= 47 | issue= 1 | pages= 3-10 | pmid=11803185 | doi=10.1159/000047939 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11803185  }}</ref>
 
===Hyponatremia===
The rate of correction of [[hyponatremia]] should be 0.5-1.0meq/L/hr, with not more than a 12 meq/l correction in 24 hrs. If the patient has ongoing [[seizures]] (or [Na<sup>+</sup>]<115 meq/li), correction can be attempted at up to 2 meq/L/hr, but only while [[seizure activity]] lasts and the [Na<sup>+</sup>] exceeds 125-130 meq/Li.


===Hypernatremia===
Alcoholic patients should receive vitamin supplementation including [[vitamin B6]], [[Vitamin B9|B9]] and [[Vitamin B12|B12]] and evaluation of their nutritional status.<ref name="pmid7466381">{{cite journal| author=Kleinschmidt-DeMasters BK, Norenberg MD| title=Rapid correction of hyponatremia causes demyelination: relation to central pontine myelinolysis. | journal=Science | year= 1981 | volume= 211 | issue= 4486 | pages= 1068-70 | pmid=7466381 | doi=10.1126/science.7466381 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7466381  }}</ref>
The rate of correction of [[hypernatremia]] should be at 0.5meq/L/hr and should not exceed 12 meq/Li/24hrs.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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Latest revision as of 20:38, 7 July 2020

Template:Central pontine myelinolysi Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

Treatment of patients with central pontine myelinolysis is mainly supportive because once the osmotic demyelination has begun, there is no cure or specific treatment. Alcoholic patients should receive vitamin supplementation including vitamin B6, B9, and B12 and evaluation of their nutritional status.

Medical Therapy

Treatment of patients with central pontine myelinolysis is mainly supportive because once the osmotic demyelination has begun, there is no cure or specific treatment.[1][2]

Alcoholic patients should receive vitamin supplementation including vitamin B6, B9 and B12 and evaluation of their nutritional status.[3]

References

  1. ↑ Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D; et al. (2014). "Clinical practice guideline on diagnosis and treatment of hyponatraemia". Eur J Endocrinol. 170 (3): G1–47. doi:10.1530/EJE-13-1020. PMID 24569125.
  2. ↑ Lampl C, Yazdi K (2002). "Central pontine myelinolysis". Eur Neurol. 47 (1): 3–10. doi:10.1159/000047939. PMID 11803185.
  3. ↑ Kleinschmidt-DeMasters BK, Norenberg MD (1981). "Rapid correction of hyponatremia causes demyelination: relation to central pontine myelinolysis". Science. 211 (4486): 1068–70. doi:10.1126/science.7466381. PMID 7466381.

Template:WH Template:WS

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