Transient athetoid involuntary movement in a patient with chronic renal failure, possibly due to rapid correction of hyponatremia by hemodialysis Hiro
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1 Transient athetoid involuntary movement in a patient with chronic renal failure, possibly due to rapid correction of hyponatremia by hemodialysis Hiroki Sasage, Yoshiki Suzuki, Fumitake Gejyo, Takashi Inuzuka*, Masaaki Arakawa Second Department of Internal Medicine, and Neurology*, Niigata University School of Medicine A 52-years-old woman was admitted for exacerbation of edema and severe azotemia. Her sodium (Na) concentration was as low as 123mEq/l on admission. Treatment with hemodialysis (HD) was started because of the progressing azotemia. Serum Na concentrations were 112 and 131mEq/lat the start and the end of the first HD, respectively. During the second HD 3 days after the first HD, athetoid involuntary movements (IVM) of the right upper and lower extremities suddenly occurred. The IVM tended to improve after interruption of HD but still appeared intermittently. Serum Na concentrations before and after the second HD were 127 and 138 meq/l respectively. The neurological examination revealed saccadic eye movements and increased deep tendon reflexes. IVM disappeared after oral administration of clonazepam the next day, and did not recur even after discontinuing clonazepam on the ninth day. The MRI examination of brain after 40 days, failed to detect any abnormal findings in the pons and elsewhere. No remarkable abnormalities were found in electroencephalograms on the next day and two months later. We suspect that the cause of neurological symptoms in this case was due to the rapid correction of hyponatremia by HD. Since hyponatremia often occurs at the end stage chronic renal failure, the correction of the electrolyte disorder should be made carefully.
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