To view enhanced digital features for this article go to https://doi.org/10.6084/m9.figshare.7770347.
We present a case wherein diabetic ketoacidosis (DKA) was treated with a large amount of sodium bicarbonate and potassium chloride, resulting in the development of osmotic demyelination syndrome (ODS).
Our patient was a 29-year-old male with a history of post-surgical repair for ventricular septal defect. Upon arrival, the patient’s Glasgow Coma Scale (GCS) score was E2M4V3. Laboratory examinations revealed leukocytosis, severe metabolic acidosis, hypokalemia, and hyperglycemia. His consciousness status and hemodynamics improved after resuscitation (GCS: E3M6Ve). However, they declined at the 40th hour of admission and dropped to GCS E2M2Ve. Magnetic resonance imaging revealed multifocal abnormal signal intensity changes in the whole brain stem. The diagnosis of type 1 diabetes mellitus was made during the hospitalization period. The patient exhibited improved consciousness status after 17-day medical care at the ICU.
We recommend that in the case of DKA, the correction of hypokalemia should be prioritized during treatment. Sodium bicarbonate infusion should be reserved for pH < 6.9. In addition, close monitoring of the serum sodium level and prompt actions to lower it if it exceeds the threshold may be necessary.
Dagur G, Khan SA. Current concepts in pontine myelinolysis: review of literature. Transl Biomed. 2015;6:4.
Rodríguez-Velver KV, Soto-Garcia AJ, Zapata-Rivera MA, Montes-Villarreal J, Villarreal-Pérez JZ, Rodríguez-Gutiérrez R. Osmotic demyelination syndrome as the initial manifestation of a hyperosmolar hyperglycemic state. Case Rep Neurol Med. 2014;2014:1–5. CrossRef
Chua H, Schneider A, Bellomo R. Bicarbonate in diabetic ketoacidosis—a systematic review. Ann Intensive Care. 2011;1:1–12. CrossRef
Koul PA, Khan UH, Jan RA, Shah S, Qadri AB, Wani B, et al. Osmotic demyelination syndrome following slow correction of hyponatremia: possible role of hypokalemia. Indian J Crit Care Med. 2013;2013(17):231–3.
- Excessive Sodium Bicarbonate Infusion May Result in Osmotic Demyelination Syndrome During Treatment of Diabetic Ketoacidosis: A Case Report
- Springer Healthcare
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II