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Central pontine (and extrapontine) myelinolysis despite appropriate sodium correction
  1. Andrew Micieli1,
  2. Umberin Najeeb2,
  3. William Kingston1
  1. 1 Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2 Department of Medicine, University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
  1. Correspondence to Dr Andrew Micieli, Neurology, University of Toronto Faculty of Medicine, Toronto, ON M5S 1A8, Canada; andrew.micieli{at}

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A 55-year-old woman presented to the emergency department with generalised weakness and lightheadedness. She had a history of depression, hypertension, coeliac disease and excessive alcohol use. There were no focal neurological symptoms/signs. Abnormal laboratory results included serum sodium of 99 mmol/L, potassium of 3.0 mmol/L, serum osmolality of 214 mmol/kg, urine sodium of 32 mmol/L and urine osmolality of 630 mmol/kg. We suspected that her hyponatraemia was multifactorial, with contribution from escitalopram, hydrochlorothiazide, diuretic use and excessive alcohol intake. Further investigations found no evidence of primary hyperaldosteronism, adrenal insufficiency, hypothyroidism …

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  • Contributors AM: involved in conception, writing and editing the manuscript. UN: involved in writing and editing the manuscript. WK: involved in conception, writing and editing the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed by Martin Duddy, Newcastle-upon-Tyne, UK.