Osmotic
demyelination syndrome is an uncommon neurologic condition, characterized by noninflammatory
demyelination involving the pons and other areas of the central nervous system. As chronic
hyponatremia is frequently associated with
cirrhosis, patients undergoing
liver transplantation are at an increased risk for developing this condition. We report the case of a patient who developed refractory
hypernatremia and osmotic
demyelination syndrome after
liver transplantation. The patient was a 40-year-old man, who underwent
liver transplantation for the treatment of
cryptogenic cirrhosis, and had a preoperative
sodium level of 128 mmol/L. Although there were no
intraoperative complications, the patient showed signs of mental
confusion and drowsiness in the second postoperative day, and we noticed an increase to 136 mmol/L in his serum
sodium. Treatment with 5%
dextrose and
desmopressin was initiated, but his serum
sodium continued to increase steadily, while his neurologic condition gradually worsened. Serum
sodium rose to 157 mmol/L, and a magnetic resonance imaging of the brain showed extensive lesions consistent with osmotic
demyelination syndrome. The clinical condition of the patient continued to deteriorate until his death 17 days after the transplant. Although the occurrence of this syndrome after
liver transplantation is well described, the steady increase in serum
sodium despite early treatment, as described in this case, is highly unusual, and highlights the great attention that must be taken with monitoring and control of serum
sodium in patients who undergo
liver transplant in the context of chronic
hyponatremia. This manuscript is compliant with the Helsinki Congress and the Istanbul Declaration.