Central pontine myelinolysis secondary to rapid correction of hyponatremia historical perspective with Doctor Robert Laureno.

ABSTRACT

OBJECTIVES: Central pontine myelinolysis (CPM) is a neurological disorder characterized by damage to the myelin and oligodendrocytes in the pons. This review focuses on the history of CPM and the discovery of its association with the treatment of hyponatremia. METHODS: The author reviewed original publications regarding CPM, hyponatremia, and the treatment of hyponatremia. The author interviewed Dr. Robert Laureno who was a pioneer in CPM research with his animal work in dogs. RESULTS: Animal models demonstrated the role of the rapid correction of hyponatremia as causative of pontine and extrapontine myelinolytic lesions. Nevertheless, the importance of the speed of correction was widely denied. There were years of debates and only slow changes in expert guidelines. CONCLUSION: CPM occurs as a consequence of a rapid rise in serum sodium in individuals with chronic hyponatremia. It is recommended to increase plasma sodium concentration by no more than 8 to 10 mmol/L per 24 h in chronic hyponatremia.