Osmotic Demyelination Syndrome in a Patient with Diabetic Ketoacidosis Despite No Rapid Sodium Correction

Toshiyuki Nakanishi; Satoko Tamaru; Taku Harada; Kenta Shukuya; Kazushi Yamasato; Jun Kataoka; Kohzoh Makita; Mori Nakai

doi:10.2169/internalmedicine.2451-23

Osmotic Demyelination Syndrome in a Patient with Diabetic Ketoacidosis Despite No Rapid Sodium Correction

Intern Med. 2023 Oct 20. doi: 10.2169/internalmedicine.2451-23. Online ahead of print.

Authors

Toshiyuki Nakanishi¹, Satoko Tamaru¹, Taku Harada¹, Kenta Shukuya¹, Kazushi Yamasato¹, Jun Kataoka², Kohzoh Makita³, Mori Nakai¹

Affiliations

¹ Department of General Medicine, Nerima Hikarigaoka hospital, Japan.
² Department of Critical Care Medicine, Nerima Hikarigaoka hospital, Japan.
³ Department of Radiology, Nerima Hikarigaoka hospital, Japan.

PMID: 37866918
DOI: 10.2169/internalmedicine.2451-23

Abstract

Osmotic demyelination syndrome (ODS) occurs in patients with diabetes and hyponatremia. We herein report a case of ODS with chorea detected on serial magnetic resonance imaging (MRI), despite no prompt hyponatremia correction. A 74-year-old man with cirrhosis and uncontrolled type 2 diabetes developed an altered mental status and chorea during treatment for diabetic ketoacidosis (DKA). Despite no rapid sodium correction and normal initial brain MRI findings, serial MRI revealed ODS-related abnormalities. Clinicians should consider ODS in patients with DKA and a hyperosmolar hyperglycemic state displaying unconsciousness and neurological manifestations, including chorea, even without substantial changes in serum sodium levels. An MRI re-examination can help capture missing ODS complications.

Keywords: Chorea; Diabetic ketoacidosis; Hyponatremia; Osmotic demyelination syndrome; Serial MRI.