Development of central pontine myelinolysis from hepatic injury and liver transplantation: A narrative review.

Abstract

Controlling serum osmolarity levels is a homeostatic mechanism that allows the body to manage sudden changes in water and electrolyte concentrations. Rapid correction of hyponatremia is an example of how such an imbalance might be addressed; however, this may give rise to serious consequences. Among these is a neurological condition called central pontine myelinolysis (CPM), which often develops from a swift correction of hyponatremia. Patients who present with a liver injury (LI), such as cirrhosis and alcoholic liver disease, may suffer from hyponatremia, thus making them susceptible to CPM. Individuals who receive a liver transplant (LT) often experience a similar risk. It is for this reason that physicians must actively devise innovative ways of performing these surgical operations without jeopardizing the neurological state of their patients. Administering liquid solutions to maintain proper serum osmolarity is a technique that is often used to prevent the development of CPM, but albumin infusions also appear to have a protective effect. Early interventions, however, are at the forefront of ongoing research regarding CPM management in LT patients. Examples include the integration of machine learning models to help determine the best correction rates for hyponatremia, as well as the use of biomarkers to help detect CPM before extensive electrolyte imbalances. These techniques present groundbreaking opportunities for physicians who wish to optimize LT procedures by minimizing neurological effects such as CPM. This paper discusses the literature on CPM onset in LI patients with electrolyte imbalance. Results established a clear connection between liver pathology and CPM occurrence.