Central Pontine Myelinolysis(CPM) is now well established to be associated with over correction of hyponatremia. It is very interesting to note how that came about. Historically, this is a very fascinating story. Here it is in a bulleted summary.
1959: Adams et al described CPM as a potential disorder. They found it in alcoholics and malnourished and chronically ill individuals. They called it "new disease" and no cases reported prior to those years.
1963: Aleu and Terry noted that perhaps an iatrogenic agents were involved and that it happened predominately in the hospital setting.
1966: More lesions identified and not localized to the Pons. It became evident by observation that all had chronic conditions such as liver disease, sepsis, burns, and cancer.
1977: Burcar et al identified 15 cases and 12 had hyponatremia. Overall, 61% of cases of CPM were associated with hyponatremia.
1979: Messert et al made the most important observation that CPM was recognized only after the advent of IV fluids therapy in the late 1950s. ( reminds us of the MRI and gadolinium association )
1979: Kevin Leslie, a pathology resident was doing an autopsy case of CPM in a jaundiced patient. He noticed a striking green discoloration in the PONS- likely secondary to breakdown of BBB leading to albumin bound bile pigment to get there. Review of literature confirmed this in many CPM cases.
1979: Scott Venderberg, pathology resident was reviewing a CPM case. He mentioned; " could this discoloration be due to osmotic stress?". This bought to light if the correction of the Na was the factor and not the Na itself.
1980-82: 15 cases of CPM with hyponatremia were reviewed and found that all 15 cases had experienced a 20-30meq/L rise in serum sodium in 3-10 days ( mean of 6 days) before CPM developed.
1982: Similar findings were confirmed in rats made hyponatremic and then given hypertonic saline quickly.
1984: patients with hyponatremia for a short period of time( hours to a few days) did not develop CPM but patients with chronic hyponatremia did.
This is a fascinating history and great discovery. This points to a great observation power of these individuals and putting it together and what is now common knowledge in the Nephrology world.
For a complete reference: http://www.ncbi.nlm.nih.gov/pubmed/20182780
- ► 2021 (22)
- ► 2020 (32)
- ► 2019 (42)
- ► 2018 (57)
- ► 2017 (52)
- ► 2016 (45)
- ► 2015 (63)
- ► 2014 (95)
- ► 2013 (133)
- TOPIC DISCUSSION: The BAMBI tale of the Kidney
- IMMUNOSUPPRESSION IN THE ELDERLY: WHATS THE BEST I...
- CLINICAL CASE 50: Answers and Summary
- HISTORY LESSON: Story Behind Central Pontine Myeli...
- New drug labels for kidney disease patients -- wha...
- Are dialysis patients at an increased risk of GI b...
- IN THE NEWS: LUNAR TRIAL
- FDA Approves Glucarpidase to Reduce Toxic Levels o...
- IN THE NEWS: Soluble FLT-1 and ANCA... Not just pr...
- ANAGRAMS: Secondary causes of ANCA disease
- eAJKD PODCAST: APOL1 and the Kidney
- Nephrology Crosswords: Interventional Nephrology
- TOPIC DISCUSSION: Atypical ANCA and it's significa...
- eAJKD: Anemia story
- eAJKD: Interest in Nephrology declining
- IN THE NEWS: Face Transplantation
- Detective Nephron: Next venture
- eAJKD: Hypertension, hypokalemia and MPGN
- CLINICAL CASE 49: Answers and Discussion
- IN THE NEWS: Which glomerular disease is highest r...
- Consult Rounds: Renal disease in Retroperitoneal F...
- Kidney Transplantation Induction Quiz Answers
- ▼ January (23)
- ► 2011 (370)
- ► 2010 (461)