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Washington University Experience | MYELIN (NON-IMMUNE MEDIATED) | Central Pontine Myelinolysis (CPM) | 5A0 Case 5 History
Case 5 History ---- This 44 year old female was brought to the ER after being found unresponsive by neighbors. An empty pill bottle and bottle of wine and several insulin syringes were found with her. Past medical history included: 1) Insulin requiring diabetes since the age of 31 with numerous past admissions for hypo- and hyperglycemia. 2) Cirrhosis, alcoholic, biopsy proven. 3) Chronic pancreatitis with secondary malabsorption. 4) Sickle cell trait. 5) Drug abuse. 6) Multiple past infections including a Staph arthritis, pneumococcal pneumonia, and Klebsiella sepsis with ARDS. 6) A positive PPD. 7) A history of positive stool guaiacs. 8) peripheral neuropathy. 9) A history of hyperkalemia with hyponatremia treated symptomatically with Fluorinef. There was marked increased tone in both lower extremities with upgoing toes. The electrolytes showed a sodium of 150, potassium 3.1, chloride 111, and bicarb 12. The creatinine was 4. The serum glucose was 265. Her hospital course included an emergency CT scan of the head which showed a lucency in the central pons. Over the next several days her diabetes and pancreatitis were treated medically. She remained comatose throughout her hospital course. The first day following her admission her Doll's eyes and ice water calories became abnormal but reverted after several days. She continued to show occasional purposeful movements in both upper extremities. She was treated with Decadron for the first two weeks of her hospitalization. She continued to receive supportive and nutritional therapy throughout her course; however, her neurologic exam remained essentially unchanged. On the 31st hospital day, she experienced a cardiorespiratory arrest and died.
