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Case Report | Medicine | Volume 15 Issue 7, July 2026 | Pages: 756 - 758 | India
Delayed Osmotic Demyelination Syndrome Following Spontaneous Correction of Profound Chronic Hyponatremia in a Chronic Alcoholic Despite Guideline-Based Management: A Case Report
Abstract: Background: Osmotic demyelination syndrome (ODS) is a rare but devastating neurological disorder that classically develops following rapid correction of chronic hyponatremia. Patients with chronic alcoholism, malnutrition, liver disease, and severe hypokalemia are particularly susceptible because of impaired cerebral osmoadaptation. Although iatrogenic sodium correction is the most frequently recognized precipitating factor, spontaneous correction following restoration of renal free-water excretion remains an underrecognized mechanism that may result in similar neurological injury. Case Presentation: A 26-year-old male with a history of chronic alcohol consumption presented with fever of ten days' duration, recurrent vomiting, oliguria, altered sensorium, agitation, and confusion. Initial laboratory investigations demonstrated profound hyponatremia (serum sodium 100 mmol/L), severe hypokalemia (1.6 mmol/L), and acute kidney injury (serum creatinine 2.3 mg/dL), consistent with chronic hypovolemic hyponatremia complicated by significant electrolyte depletion. The patient was managed according to contemporary recommendations for symptomatic chronic hyponatremia with cautious isotonic saline administration, potassium replacement, thiamine supplementation, nutritional support, and close neurological and biochemical monitoring. Hypertonic saline, sodium bicarbonate, or other hyperosmolar therapies were not administered during hospitalization. Despite conservative management, serial biochemical monitoring demonstrated a spontaneous increase in serum sodium concentration from 100 mmol/L to 124 mmol/L within the first 24 hours. An early magnetic resonance imaging (MRI) examination performed because of persistent neurological symptoms revealed no evidence of osmotic demyelination. However, the patient subsequently developed dysarthria, dysphagia, recurrent generalized seizures, respiratory failure requiring mechanical ventilation, aspiration pneumonia, sepsis, and autonomic instability. Repeat MRI performed approximately one week later demonstrated characteristic pontine signal abnormalities with the classical "Piglet sign," confirming osmotic demyelination syndrome. Conclusion: This case illustrates spontaneous correction of profound chronic hyponatremia following restoration of effective circulating volume in a chronic alcoholic with severe hypokalemia. It highlights that ODS may occur despite guideline-based conservative management and in the absence of hypertonic saline administration. Recognition of spontaneous water diuresis, meticulous biochemical monitoring, and awareness of delayed radiological manifestations are essential in high-risk patients.
Keywords: Osmotic demyelination syndrome, Central pontine myelinolysis, Hyponatremia, Chronic alcoholism, Hypokalemia, Spontaneous sodium correction, Free water diuresis
How to Cite?: Dr. Shaleen Chauhan, Dr. Kanishka Trivedi, Dr. Pankaj Gandhi, "Delayed Osmotic Demyelination Syndrome Following Spontaneous Correction of Profound Chronic Hyponatremia in a Chronic Alcoholic Despite Guideline-Based Management: A Case Report", Volume 15 Issue 7, July 2026, International Journal of Science and Research (IJSR), Pages: 756-758, https://www.ijsr.net/getabstract.php?paperid=SR26709111545, DOI: https://dx.doi.org/10.21275/SR26709111545