When to Consider Osmotic Demyelination Syndrome without Hyponatremia

Osmotic demyelination syndrome (ODS) is a feared complication of rapid hyponatremia correction. Clinical findings can include altered mental status, dysphagia/dysarthria, or quadriparesis (see Figure 1). However, accumulating evidence suggests that ODS can also occur in patients with normonatremia or hypernatremia, yet systematic data on nonhyponatremia-related ODS remain scarce. To provide new insights, researchers performed a systematic review of case reports from the past 35 years in 169 patients who developed ODS with serum sodium ≥135 mmol/l.