Abstract

Background: Palliative care receives referrals of most patients perceived to be dying in acute hospitals. Occasionally, patients with rare and complex conditions are referred and this requires a rapid learning curve for the palliative care team to ensure correct decisions are made. Central pontine myelinolysis is a type of osmotic demyelination syndrome that is characterised by damage to areas of the brain following rapid correction of hyponatremia. Methods: This case describes the presentation of a 39-year-old female admitted to an acute hospital with reduced level of consciousness and hyponatremia on a background of on-going excessive alcohol intake. Despite gradual correction, the sodium levels rose dramatically from 97mmol/L to 116mmol/L over 12 hours. Patient’s neurological condition deteriorated rapidly requiring escalation to intensive care unit and intubation. Initial CT scans of the brain did not report any intracranial abnormalities. Results: A subsequent MRI scan of the brain confirmed diagnosis of central pontine myelinolysis. Patient continued to receive supportive care but unfortunately made no neurological recovery and died as result of complications from central pontine myelinolysis. Conclusions: This case outlines the complex ethical decisions faced by a Specialist Palliative Care team while dealing with rare conditions, which require rapid learning, integration with other specialities to empower correct decisions on End-of-Life or not. The importance of how to communicate in positive versus negative language at End-of-Life is also addressed. All actions of making correct medical decisions and how these decisions are imparted matters.

Keywords

palliative care, End-of-Life