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
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