Table 1.

Patients with initial serum sodium <115 mEq/L who experienced osmotic demyelination syndrome

ReferenceAge/ SexInitial SNa (mEq/L)Factors Increasing Risk of ODSΔSNa at 24 h (mEq/L)ΔSNa at 48 h (mEq/L)Maximum ΔSNa (mEq/L per day)ODS Symptoms (Onset)Brain MRIFinal Outcome
Koul et al. (29)47/M94HypokalemiaNot reportedNot reported≤8aLocked in
(day 3)
CPM and EPMDied of sepsis
de Souza et al. (30)50/M98None mentioned4139Dysarthria, dysphagia, rigidity, normal reflexes, positive glabellar tap, grasp and palmomental reflexes, bradykinesia, parkinsonian gait
(day 15)
CPM and EPMMild gait dysfunction, urge incontinence
John et al. (8)65/F100None mentioned8168Dysphasia, psychosis, dyskinesia
(day 3)
No lesionsResolution
Leens et al. (31)54/F100Alcohol use disorder; hypokalemia101810Tetraplegic, pseudobulbar palsy, seizure, strabism
(day 5)
CPM and EPMNear complete recovery
Al-Shaibany et al. (32)48/F101Alcohol use disorder; liver disease101610Leg weakness, scanning speech
(day 12)
CPMImproved at discharge
Silbert et al. (33)51/F101None mentioned101410Behavioral changes, dysarthria
(day 16)
CPM and EPMPartial resolution with residual pseudobulbar dysarthria
Reijnders et al. (34)57/M105Alcohol use disorder; malnutrition71710Dysphagia, ataxia, spasticity
(day 11)
CPMNear complete recovery
Malhotra et al. (35)48/M107Alcohol use disorder; liver disease; malnutrition8168Ataxia, dysarthria, weakness, spastic quadriparesis
(day 14)
CPMAtaxia improved
Dellabarca et al. (36)63/M109Alcohol use disorder; malnutrition101710Dysarthria, dysphagia, bilateral cogwheel rigidity
(day 10)
CPM and EPMDeath due to respiratory failure
Yamada et al. (19)61/F109None mentioned5105Spastic tetraparesis, dysarthria, nystagmus, disturbed consciousness
(day 5)
CPMComplete resolution
Macmillan et al. (4)70–74/M111Alcohol use disorder;
liver disease; malnutrition; hypokalemia
101310Symptoms not described by authors
(day 4)
Areas of lesions not specifiedUnknown residual deficits
Dewitt et al. (37)37/F112Liver disease9179Decerebrate posturing, disorientation, hyperreflexia, impaired horizontal eye movements
(day 4)
CPMImproved with mild spasticity of lower extremities after 8 months
  • SNa, serum sodium concentration; ODS, osmotic demyelination syndrome; ΔSNa, change in SNa; MRI, magnetic resonance imaging; M, male; CPM, central pontine myelinolysis; EPM, extrapontine myelinolysis; F, female.

  • a Correction did not exceed 8 mEq/L on any day, precise values not provided; treated with 3% saline until SNa reached 120 mEq/L.