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[Clinical Picture] More haste, less speed: hyponatraemia and osmotic demyelination

A 62-year-old man with a history of heavy alcohol abuse was admitted to our hospital with chronic diarrhoea, confusion, and weakness in both legs. Initial physical examination showed marked cachexia and decreased strength in both lower limbs. His sensation was intact. Laboratory testing showed several electrolyte abnormalities—presumed to be due to his diarrhoea—including hyponatraemia (130 mmol/L); this was gradually corrected over the course of 4 days, using 0·9% sodium chloride. At the end of this period, the sodium was 140 mmol/L (normal range 135–145 mmol/L).