Central Pontine Myelinolysis Induced by Rapid Correction of Hyponatremia in a Patient With Chronic Alcohol Use Disorder: A Case Report

Central pontine myelinolysis (CPM) is a demyelinating disorder often associated with the rapid correction of hyponatremia. Elevated creatine phosphokinase (CPK) levels have been observed in some cases of CPM but are not well studied. A 38-year-old patient with chronic alcohol use disorder presented with jerky movements, confusion, and disorientation following severe hyponatremia. Initial lab results revealed severe hyponatremia (113 mmol/L) (reference range: 136-145 mmol/L), elevated liver enzymes, and extremely high CPK levels (up to 92,763 U/L) (reference range: <190 U/L). Imaging showed bilateral thalamic and pontine hypodensities, with MRI confirming CPM in the central pons. This case highlights the risk of CPM due to rapid sodium correction in patients with chronic alcohol use disorder and suggests that elevated CPK levels may be associated with CPM. The patient's condition improved with gradual sodium correction and alcohol withdrawal management. This underscores the importance of careful electrolyte management to prevent CPM and suggests further investigation into the role of highly elevated CPK in CPM. The occurrence of CPM in a patient with chronic alcohol use disorder and elevated CPK levels emphasizes the need for cautious sodium correction, with the association between elevated CPK and CPM warranting further study.