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Washington University Experience | MYELIN (NON-IMMUNE MEDIATED) | Central Pontine Myelinolysis (CPM) | 1A0 Case 1 History
Case 1 History ---- The decedent was a 49-year-old woman initially admitted to an outside hospital for fevers, weakness and diarrhea. She developed altered mental status and respiratory failure requiring intubation followed by acute hepatic failure, shock and hepatic encephalopathy. She was treated with 10-days of IV antibiotics for what was thought to be multifocal pneumonia. A bronchoalveolar lavage was positive for rhinovirus/enterovirus and gram stain showed rare mixed organisms and Candida. Her serum chemistries showed sodium level ranging from 148-151. She was given free water and her sodium decreased to 134. She developed acute kidney injury and became hyperkalemic with a potassium level of 5.1 which increased to 6.9 on 7/7/16. BUN was increased at 99. She was not a candidate for dialysis. Brain MRI from 6/24/16 showed findings favoring central pontine myelinolysis. Her clinical status in the intensive care unit continued to decline as she developed worsening acute respiratory failure and septic shock. Care was withdrawn and the patient died.
