Transient athetoid involuntary movement in a patient with chronic renal failure, possibly due to rapid correction of hyponatremia by hemodialysis.

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  • Sasage Hiroki
    Second Department of Internal Medicine, Niigata University School of Medicine
  • Suzuki Yoshiki
    Second Department of Internal Medicine, Niigata University School of Medicine
  • Gejyo Fumitake
    Second Department of Internal Medicine, Niigata University School of Medicine
  • Inuzuka Takashi
    Neurology, Niigata University School of Medicine
  • Arakawa Masaaki
    Second Department of Internal Medicine, Niigata University School of Medicine

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Other Title
  • 低ナトリウム血症を伴った慢性腎不全患者の透析導入時に一過性のアテトーゼ様不随意運動を起こした１例

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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/l at 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 138mEq/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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