More haste, less speed-hyponatraemia & osmotic demyelination
The present case has been reported in LANCET.

A 62-year-old man with a history of heavy alcohol abuse was admitted to with chronic diarrhoea, confusion, and weakness in both legs. Initial physical examination showed marked cachexia and decreased strength in both lower limbs. His sensation was intact.

Laboratory testing showed several electrolyte abnormalities-presumed to be due to his diarrhoea-including hyponatraemia (130 mmol/L); this was gradually corrected over the course of 4 days, using 0·9% sodium chloride. At the end of this period, the sodium was 140 mmol/L (normal range 135–145 mmol/L).

Over the next few days, he continued to be encephalopathic and eventually lost motor function of his arms and legs; his pupils continued to be reactive to light and the function of his extraocular muscles remained intact.

An MRI scan of his brain revealed restricted diffusion and fluid-attenuated inversion recovery (FLAIR) showed a corresponding abnormality in the central pons that was consistent with a diagnosis of central pontine demyelination. Sadly, the patient died in the intensive care unit after his family decided to pursue palliative care.

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