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Central pontine (and extrapontine) myelinolysis despite appropriate sodium correction
  1. Andrew Micieli1,
  2. Umberin Najeeb2,
  3. William Kingston1
  1. 1Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2Department 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}mail.utoronto.ca

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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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