Table 2.

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
Hu et al. (23)30/M115High ammonia levels595Dysarthria, dysphagia, exaggerated deep tendon reflexes
(day 2)
EPMNo improvement
Pradhan et al. (17)55/M115Malnutrition374Spastic quadriparesis, brisk deep tendon reflexes, positive Babinski in right
(day 8)
CPMNo improvement, patient death
Macmillan et al. (4)60–64/M115Alcohol use disorder; liver disease; malnutrition767Symptoms not described by authors
(day 12)
Areas of lesions not specifiedUnknown residual deficits
Pradhan et al. (17)39/M118Malnutrition484Dysarthria, dysphagia, rigidity, impaired horizontal eye movement, decorticate posturing, brisk deep tendon reflexes, positive Babinski bilaterally
(day 6)
CPM and EPMIncomplete recovery. Able to feed himself, speak few words, walk with support. Cogwheel rigidity and parkinsonian gait persisted
Zunga et al. (16)65/F121Hypokalemia6126Altered sensorium, stuporous
(on admission)
EPMFull recovery
Orakzai et al. (38)52/M122Alcohol use disorder; malnutrition8168Nonverbal, decreased right hand grip strength, paralysis of other extremities, Babinski positive bilaterally, pupillary responses sluggish
(day 5)
CPMComplete resolution
Jahan et al. (39)55/M123Alcohol use disorder; malnutrition555Encephalopathic, dysarthria, dysphagia, ophthalmoplegia, brisk deep tendon reflexes in all extremities
(day 7)
CPM and EPMDysarthria, dysphagia, neurologic exam improved “significantly”
Davenport et al. (21)63/M127Alcohol use disorder; hypokalemia; malnutrition91510
(SNa 161 on day 7)
Obtundation, comatose
(day ?)
Shah et al. (3)26/M130Alcohol use disorder; liver disease;
264Never developed ODS symptomsCPM (MRI done to evaluate lymphoma)Remained asymptomatic
  • SNa, serum sodium concentration; ODS, osmotic demyelination syndrome; ΔSNa, change in SNa; MRI, magnetic resonance imaging; M, male; EPM, extrapontine myelinolysis; CPM, central pontine myelinolysis; F, female.