Lohr J W
School of Medicine and Biomedical Sciences, State University of New York at Buffalo.
Am J Med. 1994 May;96(5):408-13. doi: 10.1016/0002-9343(94)90166-x.
The osmotic demyelination syndrome (ODS) is a neurologic complication associated with rapid correction of hyponatremia. A case is described in which the patient was found to have hypokalemia as well as hyponatremia prior to the development of ODS. The literature was reviewed for cases of ODS in which patients had hyponatremia (serum sodium < or = 126 mmol/L) at presentation followed by correction of the hyponatremia. Of the 74 cases in which serum sodium and serum potassium values were reported at the time of presentation, 66 patients (89%) had hypokalemia. In 20 of these cases, serial measurements of sodium and potassium were reported, and in no instance was the potassium level normalized prior to the time of most rapid correction of the serum sodium. Hypokalemia may predispose patients to develop osmotic demyelination following correction of hyponatremia. The etiology of this complication is unclear. In neurologically stable patients with severe hyponatremia, it may be beneficial to correct hypokalemia prior to correction of the serum sodium. This maneuver may further reduce the incidence of ODS.
渗透性脱髓鞘综合征（ODS）是一种与低钠血症快速纠正相关的神经并发症。本文描述了一例患者，在发生ODS之前被发现同时存在低钾血症和低钠血症。对文献中呈现低钠血症（血清钠≤126 mmol/L）随后低钠血症得到纠正的ODS病例进行了回顾。在74例报告了就诊时血清钠和血清钾值的病例中，66例患者（89%）存在低钾血症。在其中20例病例中报告了钠和钾的系列测量值，在血清钠最快纠正之前，没有任何一例钾水平恢复正常。低钾血症可能使患者在低钠血症纠正后易发生渗透性脱髓鞘。这种并发症的病因尚不清楚。在神经功能稳定的严重低钠血症患者中，在纠正血清钠之前纠正低钾血症可能有益。这一措施可能进一步降低ODS的发生率。
