Here, we present 2 patients who developed
central pontine myelinolysis after living-donor
liver transplant. Both patients had abnormal
sodium level before living-donor
liver transplant. Patient 1 presented with severe
hyponatremia on admission. After administration of 3% saline, her
sodium level during the first 24 hours was kept at 100 mEq/L and then increased to 116 mEq/L during the next 24 hours. The level increased 5.8 mEq/L during the 4- to 5-hour transplant procedure. Patient 2 was admitted to the hospital with an unprovoked seizure. The serum
sodium concentration was 111 mEq/L, which was treated with 3% saline infusion. Serum
sodium concentration escalated to 118 mEq/L over an 8-hour period. Intraoperatively, both patients received large amounts of replacement fluids (0.9%
normal saline and
albumin),
blood transfusion, and
sodium bicarbonate during the anhepatic phase, all of which carry high
sodium load. Variations in
sodium levels changed rapidly in patient 1 during transplant surgery. After they underwent
liver transplant, patient 1 had clear mental status and patient 2 demonstrated worsened mental status. On approximately day 14 and day 4 after
liver transplant, magnetic resonance imaging showed diffuse abnormalities of the pons, resulting in diagnosis of
central pontine myelinolysis. Although both patients survived, 1 remains in a
vegetative state and the other continues to present with mild balance and swallowing abnormalities. To reduce the chance of inadvertent overcorrection in patients with
hyponatremia, it is therefore important that
sodium concentrations should be monitored frequently and fluids and
electrolytes titrated carefully.