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April 1989

Central Pontine Myelinolysis and the Rate of Correction of Hyponatremia

Author Affiliations

Division of Neurology Department of Internal Medicine Kalafong Hospital and the University of Pretoria Pretoria 0001, South Africa
University Department of Neurology Kings College Hospital Medical School and Institute of Psychiatry London, England

Arch Neurol. 1989;46(4):359. doi:10.1001/archneur.1989.00520400013005

To the Editor.  —In describing a patient with central pontine myelinolysis (CPM) and behavioral symptoms, Price and Mesulam1 considered the development of CPM to be related to the rapid correction of hyponatremia. The serum sodium concentration in this patient on admission was 114 mmol/L and 17 hours later it was 133 mmol/L, yielding a calculated rate of correction of 1.12 mmol/L/h. That being so, we find it curious that, in discussing their case, the authors quote rates of correction (for sodium concentrations of ≤105 mmol/L) of 2 mmol/L/h2 as being advisable. Indeed, from their own experience, we would have expected them to have joined the vanguard advocating a slower rate of correction,3,4 particularly as the only symptom of hyponatremia in their patient was orthostatic hypotension. Thus, in a situation of this nature it might have been preferable to increase the serum sodium concentration at a rate not

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