20.500.12556/DiRROS-31920 Hypernatremia as the initial presentation of osmotic demyelination syndrome - a rare case with favorable neurological outcome Introduction: Osmotic Demyelination Syndrome (ODS) occurs due to rapid shifts in serum sodium levels and osmolality, resulting in neuronal damage. While it is most often caused by the rapid correction of chronic hyponatremia, other electrolyte imbalances have also been identified as potential triggers. Risk factors include alcohol abuse, malnutrition, and liver disease, among others, with common symptoms including tetraparesis, dysphagia, and altered consciousness. Case Presentation: We report the case of a 45-year-old male with alcohol dependence who presented to the emergency department with hypernatremia (154 mmol/L), altered mental status, and slurred speech. Despite gradual sodium correction, his condition deteriorated, and head MRI revealed findings consistent with central pontine myelinolysis and Wernicke's encephalopathy. After five months of hospitalization for severe ODS, including the need for a tracheostomy and gastrostomy, extensive rehabilitation enabled the patient to regain full independence in daily activities. Conclusion: This is a rare case of ODS presenting with hypernatremia in the setting of dehydration, malnutrition, and alcohol dependence. A preceding chronic osmotic adaptation, possibly related to unrecognized hyponatremia, may have contributed, although this could not be confirmed. Early detection, aided by MRI, was critical. Despite the severity of ODS, gradual correction of hypernatremia and extensive rehabilitation led to substantial recovery, highlighting the importance of long-term management and rehabilitation in improving patient outcomes. osmotic demyelination syndrome hypernatremia pontine myelinolysis true false true Angleški jezik Ni določen Neznano 2026-08-18 14:15:46 2026-08-18 14:15:46 2026-08-19 03:46:21 0000-00-00 00:00:00 2026 0 0 Nasl. z nasl. zaslona; Opis vira z dne 10. 7. 2026; str. 448-454 issue 1 Vol. 18 2026 0000-00-00 Zaloznikova Objavljeno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 616.8 1662-680X 10.1159/000552584 284312323 RAZ_Govekar_Gasper_2026.pdf RAZ_Govekar_Gasper_2026.pdf 1 0932372B2363EDF6AF147C8178223384 436ef344606ecdefe5dc6318aff5da501faae15c65cb711276175e1bb7d5e6e8 a5ff8408-9afe-11f1-af5a-001a4af901a5 https://dirros.openscience.si/Dokument.php?lang=slv&id=49661 https://karger.com/crn/article/doi/10.1159/000552584/951851/Hypernatremia-as-the-Initial-Presentation-of 1 8b937cf8-9afe-11f1-af5a-001a4af901a5 https://dirros.openscience.si/Dokument.php?lang=slv&id=49660 Univerzitetni klinični center Ljubljana 0 0 0