If hyponatremia is corrected too quickly, what neurologic complication can occur?

If hyponatremia is corrected too quickly, what neurologic complication can occur?

• A. Hyperkalemia
• B. Hyponatremia recurrence
• C. Central Pontine Myelinolysis
• D. Seizures

Answer: (C)

Rapid correction of hyponatremia can cause osmotic demyelination in the central nervous system, most characteristically a condition called central pontine myelinolysis. When the brain has adapted to low sodium, a sudden rise in serum osmolality pulls water out of brain cells too quickly, damaging myelin in the central pons. This can lead to severe neurologic deficits such as dysarthria, dysphagia, and quadriparesis, progressing to a locked-in state in severe cases. Prevention focuses on a cautious correction rate, typically not exceeding about 6–8 mEq/L in the first 24 hours (and staying well below 18 mEq/L in 48 hours) in chronic hyponatremia. If correction has overshot, strategies like desmopressin to pause diuresis and careful re-lowering of sodium may be needed. Other options listed are not the classic complication of rapid correction; hyperkalemia is not caused by correcting sodium, recurrence of hyponatremia is a separate issue, and seizures can occur with hyponatremia itself but do not specifically represent the consequence of rapid correction.

Rapid correction of hyponatremia can cause osmotic demyelination in the central nervous system, most characteristically a condition called central pontine myelinolysis. When the brain has adapted to low sodium, a sudden rise in serum osmolality pulls water out of brain cells too quickly, damaging myelin in the central pons. This can lead to severe neurologic deficits such as dysarthria, dysphagia, and quadriparesis, progressing to a locked-in state in severe cases. Prevention focuses on a cautious correction rate, typically not exceeding about 6–8 mEq/L in the first 24 hours (and staying well below 18 mEq/L in 48 hours) in chronic hyponatremia. If correction has overshot, strategies like desmopressin to pause diuresis and careful re-lowering of sodium may be needed. Other options listed are not the classic complication of rapid correction; hyperkalemia is not caused by correcting sodium, recurrence of hyponatremia is a separate issue, and seizures can occur with hyponatremia itself but do not specifically represent the consequence of rapid correction.