Pontine and extrapontine myelinolysis following liver transplantation: relationship to serum sodium
The relationship between central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) and serum sodium changes in the setting of orthotopic liver transplantation (OLT) is examined. Postmortem examination of 14 patients with end-stage liver disease who underwent liver transplantation reveal...
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| Veröffentlicht in: | Transplantation 1989-12, Vol.48 (6), p.1006-1012 |
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| container_end_page | 1012 |
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| container_title | Transplantation |
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| creator | WSZOLEK, Z. K MCCOMB, R. D PFEIFFER, R. F STEG, R. E WOOD, R. P SHAW, B. W MARKIN, R. S |
| description | The relationship between central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) and serum sodium changes in the setting of orthotopic liver transplantation (OLT) is examined. Postmortem examination of 14 patients with end-stage liver disease who underwent liver transplantation revealed CPM in four, of which three also had EPM. A retrospective review of clinical and laboratory data was performed on all patients. There were marked perioperative rises (21-32 mEq/L) in the serum sodium concentration in all four patients who developed myelinolysis. In contrast, the largest increase in sodium in patients without demyelination was 16 mEq/L. We conclude that perioperative rises in the serum sodium concentration increase the risk of myelinolysis. CPM and EPM should be considered if the patient develops mental status changes or focal neurological deficits several days after OLT. |
| doi_str_mv | 10.1097/00007890-198912000-00023 |
| format | Article |
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K ; MCCOMB, R. D ; PFEIFFER, R. F ; STEG, R. E ; WOOD, R. P ; SHAW, B. W ; MARKIN, R. S</creator><creatorcontrib>WSZOLEK, Z. K ; MCCOMB, R. D ; PFEIFFER, R. F ; STEG, R. E ; WOOD, R. P ; SHAW, B. W ; MARKIN, R. S</creatorcontrib><description>The relationship between central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) and serum sodium changes in the setting of orthotopic liver transplantation (OLT) is examined. Postmortem examination of 14 patients with end-stage liver disease who underwent liver transplantation revealed CPM in four, of which three also had EPM. A retrospective review of clinical and laboratory data was performed on all patients. There were marked perioperative rises (21-32 mEq/L) in the serum sodium concentration in all four patients who developed myelinolysis. In contrast, the largest increase in sodium in patients without demyelination was 16 mEq/L. We conclude that perioperative rises in the serum sodium concentration increase the risk of myelinolysis. CPM and EPM should be considered if the patient develops mental status changes or focal neurological deficits several days after OLT.</description><identifier>ISSN: 0041-1337</identifier><identifier>EISSN: 1534-6080</identifier><identifier>DOI: 10.1097/00007890-198912000-00023</identifier><identifier>PMID: 2595761</identifier><identifier>CODEN: TRPLAU</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott</publisher><subject>Adult ; Biological and medical sciences ; Brain Diseases - etiology ; Demyelinating Diseases - etiology ; Female ; Humans ; Liver Transplantation - adverse effects ; Liver, biliary tract, pancreas, portal circulation, spleen ; Male ; Medical sciences ; Middle Aged ; Osmolar Concentration ; Pons ; Postoperative Complications - etiology ; Sodium - blood ; Surgery (general aspects). Transplantations, organ and tissue grafts. 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P</creatorcontrib><creatorcontrib>SHAW, B. W</creatorcontrib><creatorcontrib>MARKIN, R. S</creatorcontrib><title>Pontine and extrapontine myelinolysis following liver transplantation: relationship to serum sodium</title><title>Transplantation</title><addtitle>Transplantation</addtitle><description>The relationship between central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) and serum sodium changes in the setting of orthotopic liver transplantation (OLT) is examined. Postmortem examination of 14 patients with end-stage liver disease who underwent liver transplantation revealed CPM in four, of which three also had EPM. A retrospective review of clinical and laboratory data was performed on all patients. There were marked perioperative rises (21-32 mEq/L) in the serum sodium concentration in all four patients who developed myelinolysis. In contrast, the largest increase in sodium in patients without demyelination was 16 mEq/L. We conclude that perioperative rises in the serum sodium concentration increase the risk of myelinolysis. CPM and EPM should be considered if the patient develops mental status changes or focal neurological deficits several days after OLT.</description><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Brain Diseases - etiology</subject><subject>Demyelinating Diseases - etiology</subject><subject>Female</subject><subject>Humans</subject><subject>Liver Transplantation - adverse effects</subject><subject>Liver, biliary tract, pancreas, portal circulation, spleen</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Osmolar Concentration</subject><subject>Pons</subject><subject>Postoperative Complications - etiology</subject><subject>Sodium - blood</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. 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Graft diseases</topic><topic>Surgery of the digestive system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>WSZOLEK, Z. K</creatorcontrib><creatorcontrib>MCCOMB, R. D</creatorcontrib><creatorcontrib>PFEIFFER, R. F</creatorcontrib><creatorcontrib>STEG, R. E</creatorcontrib><creatorcontrib>WOOD, R. P</creatorcontrib><creatorcontrib>SHAW, B. W</creatorcontrib><creatorcontrib>MARKIN, R. 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S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pontine and extrapontine myelinolysis following liver transplantation: relationship to serum sodium</atitle><jtitle>Transplantation</jtitle><addtitle>Transplantation</addtitle><date>1989-12-01</date><risdate>1989</risdate><volume>48</volume><issue>6</issue><spage>1006</spage><epage>1012</epage><pages>1006-1012</pages><issn>0041-1337</issn><eissn>1534-6080</eissn><coden>TRPLAU</coden><abstract>The relationship between central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) and serum sodium changes in the setting of orthotopic liver transplantation (OLT) is examined. Postmortem examination of 14 patients with end-stage liver disease who underwent liver transplantation revealed CPM in four, of which three also had EPM. A retrospective review of clinical and laboratory data was performed on all patients. There were marked perioperative rises (21-32 mEq/L) in the serum sodium concentration in all four patients who developed myelinolysis. In contrast, the largest increase in sodium in patients without demyelination was 16 mEq/L. We conclude that perioperative rises in the serum sodium concentration increase the risk of myelinolysis. CPM and EPM should be considered if the patient develops mental status changes or focal neurological deficits several days after OLT.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott</pub><pmid>2595761</pmid><doi>10.1097/00007890-198912000-00023</doi><tpages>7</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0041-1337 |
| ispartof | Transplantation, 1989-12, Vol.48 (6), p.1006-1012 |
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| language | eng |
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| source | Journals@Ovid Ovid Autoload; MEDLINE |
| subjects | Adult Biological and medical sciences Brain Diseases - etiology Demyelinating Diseases - etiology Female Humans Liver Transplantation - adverse effects Liver, biliary tract, pancreas, portal circulation, spleen Male Medical sciences Middle Aged Osmolar Concentration Pons Postoperative Complications - etiology Sodium - blood Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system |
| title | Pontine and extrapontine myelinolysis following liver transplantation: relationship to serum sodium |
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