Cerebral edema due to severe hyponatremia

Case contributed by Dr Yair Glick


Altered consciousness after ingesting an oral laxative.

Patient Data

Age: 50 years
Gender: Female

Generalized cerebral and cerebellar edema, expressed as effaced sulci and cisterns and narrowed ventricles. Gray-white matter differentiation is preserved.

Partial regression of generalized edema - sulci and cisterns are now visible.

Case Discussion

A 50 year old woman was brought to the ER with altered consciousness and confusion, after having taken a laxative in preparation for a colonoscopy. No notable history of illness or medications.
At the ER, she was stuporous and moved her limbs in reaction to pain.
Temperature 35.6°C, preserved blood pressure, mild bradycardia, and ventricular premature beats (VPBs). 
Sodium 111 mEq/L, blood pH 7.1, bicarbonate 11 mEq/L.
CT head showed generalized cerebral edema.
She was treated for hypervolemic hyponatremia.
At one point during her hospitalization, she exhibited neurological deterioration and so she underwent another CT head scan two days after the first one, which showed regression of the edema.
She was eventually released from the hospital in satisfactory condition.

NB: Care must be taken not to correct hyponatermia too rapidly, lest the patient develop osmotic demyelination syndrome.

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