Neurologic Presentations of Acid-Base Imbalance, Electrolyte Abnormalities, and Endocrine Emergencies

Neurologic Clinics

Volumn 28, Issue 1, 2010, Pages 1-16

  Yee, Alan H ^a   Rabinstein, Alejandro A ^a  

^a MAYO CLINIC   (United States)

Author keywords

Acid base; Electrolyte; Endocrine emergencies; Neurologic manifestations

Indexed keywords

ALDOSTERONE; AMMONIUM CHLORIDE; ANDROGEN; CALCIUM; CARBON DIOXIDE; CARBONATE DEHYDRATASE INHIBITOR; ETHYLENE GLYCOL; GLUCOSE; HYDROCORTISONE; INSULIN; IRON; ISONIAZID; KETONE; LITHIUM; MAGNESIUM; METFORMIN; METHANOL; OXYGEN; PARALDEHYDE; PHOSPHATE; POTASSIUM; SALICYLIC ACID DERIVATIVE; SODIUM; THYROXINE; VASOPRESSIN;

ADDISON DISEASE; ANAMNESIS; ARTERIAL CARBON DIOXIDE TENSION; BRAIN BLOOD FLOW; BRAIN HYPOXIA; CEREBRAL SALT WASTING; CLINICAL FEATURE; DIABETES MELLITUS; DIABETIC KETOACIDOSIS; DIAGNOSTIC ACCURACY; DISEASE SEVERITY; DISORDERS OF ACID BASE BALANCE; EARLY DIAGNOSIS; ELECTROLYTE DISTURBANCE; ENDOCRINE DISEASE; HUMAN; HYPERCALCEMIA; HYPERCAPNIA; HYPERKALEMIA; HYPERMAGNESEMIA; HYPERNATREMIA; HYPERPARATHYROIDISM; HYPERPHOSPHATEMIA; HYPERVENTILATION; HYPOCALCEMIA; HYPOGLYCEMIA; HYPOKALEMIA; HYPOMAGNESEMIA; HYPONATREMIA; HYPOPARATHYROIDISM; HYPOPHOSPHATEMIA; HYPOPHYSIS APOPLEXY; INAPPROPRIATE VASOPRESSIN SECRETION; LABORATORY TEST; MEDICAL ASSESSMENT; METABOLIC ACIDOSIS; METABOLIC ALKALOSIS; MYXEDEMA; NEUROLOGIC DISEASE; NONKETOTIC DIABETIC COMA; PH; PHYSICAL EXAMINATION; PRIORITY JOURNAL; RESPIRATORY ACIDOSIS; RESPIRATORY ALKALOSIS; RESPIRATORY FAILURE; REVIEW; SEIZURE; THYROID CRISIS;

ACID-BASE IMBALANCE; ENDOCRINE SYSTEM DISEASES; HUMANS; NERVOUS SYSTEM DISEASES; WATER-ELECTROLYTE IMBALANCE;

EID: 70449629842     PISSN: 07338619     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.ncl.2009.09.002     Document Type: Review

References (120)

1. Kilburn K.H. Neurologic manifestations of respiratory failure. Arch Intern Med 116 (1965) 409-415
2. Jennum P., and Borgesen S.E. Intracranial pressure and obstructive sleep apnea. Chest 95 2 (1989) 279-283
3. Kirkpatrick P.J., Meyer T., Sarkies N., et al. Papilloedema and visual failure in a patient with nocturnal hypoventilation. J Neurol Neurosurg Psychiatr 57 12 (1994) 1546-1547
4. Reeve P., Harvey G., and Seaton D. Papilloedema and respiratory failure. Br Med J (Clin Res Ed) 291 6491 (1985) 331-332
5. Varelas P.N., Spanaki M.V., Rathi S., et al. Papilledema unresponsive to therapy in Pickwickian syndrome: another presentation of pseudotumor cerebri?. Am J Med 109 1 (2000) 80-81
6. Pitt B., Sweet R., and Stein M. Respiratory failure with focal neurological sings. Arch Intern Med 115 (1965) 14-17
7. Faden A. Encephalopathy following treatment of chronic pulmonary failure. Neurology 26 4 (1976) 337-339
8. Gotoh F., Meyer J.S., and Takagi Y. Cerebral effects of hyperventilation in man. Arch Neurol 12 (1965) 410-423
9. Saltzman H.A., Heyman A., and Sieker H.O. Correlation of clinical and physiologic manifestations of sustained hyperventilation. N Engl J Med 268 (1963) 1431-1436
10. Evans R.W. Neurologic aspects of hyperventilation syndrome. Semin Neurol 15 2 (1995) 115-125
11. Perkin G.D., and Joseph R. Neurological manifestations of the hyperventilation syndrome. J R Soc Med 79 8 (1986) 448-450
12. Wijdicks E. Acid-base, electrolyte, and endocrine disorders. Neurology of critical illness (1995), F.A. Davis Company, Philadelphia p. 104-6
13. DuBose T.D. Acidosis and alkalosis. In: Braunwald E., Fauci A., Kasper D., et al. (Eds). Harrison's principles of internal medicine. 15th edition (2001), McGraw-Hill Companies, New York 283-291
14. Haber R.J. A practical approach to acid-base disorders. West J Med 155 2 (1991) 146-151
15. Ishiguchi T., Mikita N., Iwata T., et al. Myoclonus and metabolic alkalosis from licorice in antacid. Intern Med 43 1 (2004) 59-62
16. Okada K., Kono N., Kobayashi S., et al. Metabolic alkalosis and myoclonus from antacid ingestion. Intern Med 35 6 (1996) 515-516
17. Simons P., Nadra I., and McNally P.G. Metabolic alkalosis and myoclonus. Postgrad Med J 79 933 (2003) 414-415
18. Kilburn K.H. Shock, seizures, and coma with alkalosis during mechanical ventilation. Ann Intern Med 65 5 (1966) 977-984
19. Rotheram Jr. E.B., Safar P., and Robin E. Cns disorder during mechanical ventilation in chronic pulmonary disease. JAMA 189 (1964) 993-996
20. Fraley D.S., Adler S., and Bruns F. Life-threatening metabolic alkalosis in a comatose patient. Southampt Med J 72 8 (1979) 1024-1025
21. Lubash G.D., Cohen B.D., Young C.W., et al. Severe metabolic alkalosis with neurologic abnormalities; report of a case. N Engl J Med 258 21 (1958) 1050-1052
22. Adrogue H.J., and Madias N.E. Hyponatremia. N Engl J Med 342 21 (2000) 1581-1589
23. Isotani E., Suzuki R., Tomita K., et al. Alterations in plasma concentrations of natriuretic peptides and antidiuretic hormone after subarachnoid hemorrhage. Stroke 25 11 (1994) 2198-2203
24. McGirt M.J., Blessing R., Nimjee S.M., et al. Correlation of serum brain natriuretic peptide with hyponatremia and delayed ischemic neurological deficits after subarachnoid hemorrhage. Neurosurgery 54 6 (2004) 1369-1373 [discussion: 1373-4]
25. Wijdicks E.F., Vermeulen M., Hijdra A., et al. Hyponatremia and cerebral infarction in patients with ruptured intracranial aneurysms: is fluid restriction harmful?. Ann Neurol 17 2 (1985) 137-140
26. Wijdicks E.F., Vermeulen M., ten Haaf J.A., et al. Volume depletion and natriuresis in patients with a ruptured intracranial aneurysm. Ann Neurol 18 2 (1985) 211-216
27. Kim J.H., Kang J.K., and Lee S.A. Hydrocephalus and hyponatremia as the presenting manifestations of primary CNS lymphoma. Eur Neurol 55 1 (2006) 39-41
28. Poon W.S., Lolin Y.I., Yeung T.F., et al. Water and sodium disorders following surgical excision of pituitary region tumours. Acta Neurochir (Wien) 138 8 (1996) 921-927
29. Moller K., Larsen F.S., Bie P., et al. The syndrome of inappropriate secretion of antidiuretic hormone and fluid restriction in meningitis-how strong is the evidence?. Scand J Infect Dis 33 1 (2001) 13-26
30. Narotam P.K., Kemp M., Buck R., et al. Hyponatremic natriuretic syndrome in tuberculous meningitis: the probable role of atrial natriuretic peptide. Neurosurgery 34 6 (1994) 982-988 [discussion: 988]
31. Moro N., Katayama Y., Igarashi T., et al. Hyponatremia in patients with traumatic brain injury: incidence, mechanism, and response to sodium supplementation or retention therapy with hydrocortisone. Surg Neurol 68 4 (2007) 387-393
32. Arieff A.I., Llach F., and Massry S.G. Neurological manifestations and morbidity of hyponatremia: correlation with brain water and electrolytes. Medicine (Baltimore) 55 2 (1976) 121-129
33. Rabinstein A.A., and Wijdicks E.F. Hyponatremia in critically ill neurological patients. Neurologist 9 6 (2003) 290-300
34. Weiner M., and Epstein F.H. Signs and symptoms of electrolyte disorders. Yale J Biol Med 43 2 (1970) 76-109
35. Arieff A.I. Hyponatremia, convulsions, respiratory arrest, and permanent brain damage after elective surgery in healthy women. N Engl J Med 314 24 (1986) 1529-1535
36. Wijdicks E.F., and Sharbrough F.W. New-onset seizures in critically ill patients. Neurology 43 5 (1993) 1042-1044
37. Mulloy A.L., and Caruana R.J. Hyponatremic emergencies. Med Clin North Am 79 1 (1995) 155-168
38. Riggs J.E. Neurologic manifestations of electrolyte disturbances. Neurol Clin 20 1 (2002) 227-239 vii
39. Schwartz E., Fogel R.L., Chokas W.V., et al. Unstable osmolar homeostasis with and without renal sodium wastage. Am J Med 33 (1962) 39-53
40. Schwartz W.B., Bennett W., Curelop S., et al. A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. Am J Med 23 4 (1957) 529-542
41. Castilla-Guerra L., del Carmen Fernandez-Moreno M., Lopez-Chozas J.M., et al. Electrolytes disturbances and seizures. Epilepsia 47 12 (2006) 1990-1998
42. Arieff A.I., and Guisado R. Effects on the central nervous system of hypernatremic and hyponatremic states. Kidney Int 10 1 (1976) 104-116
43. Adrogue H.J., and Madias N.E. Hypernatremia. N Engl J Med 342 20 (2000) 1493-1499
44. Buruma O.J., Bots G.T., and Went L.N. Familial hypokalemic periodic paralysis. 50-year follow-up of a large family. Arch Neurol 42 1 (1985) 28-31
45. Stedwell R.E., Allen K.M., and Binder L.S. Hypokalemic paralyses: a review of the etiologies, pathophysiology, presentation, and therapy. Am J Emerg Med 10 2 (1992) 143-148
46. Ault M.J., and Geiderman J. Hypokalemia as a cause of tetany. West J Med 157 1 (1992) 65-67
47. Engel F.L., Martin S.P., and Taylor H. On the relation of potassium to the neurological manifestations of hypocalcemic tetany. Bull Johns Hopkins Hosp 84 4 (1949) 285-301
48. Van Horn G., Drori J.B., and Schwartz F.D. Hypokalemic myopathy and elevation of serum enzymes. Arch Neurol 22 4 (1970) 335-341
49. Finsterer J., Hess B., Jarius C., et al. Malnutrition-induced hypokalemic myopathy in chronic alcoholism. J Toxicol Clin Toxicol 36 4 (1998) 369-373
50. Martin J.B., Craig J.W., Eckel R.E., et al. Hypokalemic myopathy in chronic alcoholism. Neurology 21 11 (1971) 1160-1168
51. Maury E., Lemant J., Dussaule J.C., et al. A reversible paralysis. Lancet 360 9346 (2002) 1660
52. McCarty M., Jagoda A., and Fairweather P. Hyperkalemic ascending paralysis. Ann Emerg Med 32 1 (1998) 104-107
53. Tapiawala S., Badve S.V., More N., et al. Severe muscle weakness due to hyperkalemia. J Assoc Physicians India 52 (2004) 505-506
54. Patten B.M., Bilezikian J.P., Mallette L.E., et al. Neuromuscular disease in primary hyperparathyroidism. Ann Intern Med 80 2 (1974) 182-193
55. Brown S.W., Vyas B.V., and Spiegel D.R. Mania in a case of hyperparathyroidism. Psychosomatics 48 3 (2007) 265-268
56. Chiba Y., Satoh K., Ueda S., et al. Marked improvement of psychiatric symptoms after parathyroidectomy in elderly primary hyperparathyroidism. Endocrinol Jpn 54 3 (2007) 379-383
57. Jackson C.E., Amato A.A., Bryan W.W., et al. Primary hyperparathyroidism and ALS: is there a relation?. Neurology 50 6 (1998) 1795-1799
58. Patten B.M., and Pages M. Severe neurological disease associated with hyperparathyroidism. Ann Neurol 15 5 (1984) 453-456
59. Fernandez R., Ashraf A., and Dure L.S. Nutritional vitamin D deficiency presenting as hemichorea. J Child Neurol 22 1 (2007) 74-76
60. Hirooka Y., Yuasa K., Hibi K., et al. Hyperparathyroidism associated with parkinsonism. Intern Med 31 7 (1992) 904-907
61. Kovacs C.S., Howse D.C., and Yendt E.R. Reversible parkinsonism induced by hypercalcemia and primary hyperparathyroidism. Arch Intern Med 153 9 (1993) 1134-1136
62. Tonner D.R., and Schlechte J.A. Neurologic complications of thyroid and parathyroid disease. Med Clin North Am 77 1 (1993) 251-263
63. Topakian R., Stieglbauer K., Rotaru J., et al. Hypocalcemic choreoathetosis and tetany after bisphosphonate treatment. Mov Disord 21 11 (2006) 2026-2027
64. Cheek J.C., Riggs J.E., and Lilly R.L. Extensive brain calcification and progressive dysarthria and dysphagia associated with chronic hypoparathyroidism. Arch Neurol 47 9 (1990) 1038-1039
65. Levin P., Kunin A.S., Donaghy R.M., et al. Intracranial calcification and hypoparathyroidism. Neurology 11 (1961) 1076-1080
66. Margolin D., Hammerstad J., Orwoll E., et al. Intracranial calcification in hyperparathyroidism associated with gait apraxia and parkinsonism. Neurology 30 9 (1980) 1005-1007
67. Chen T.H., Huang C.C., Chang Y.Y., et al. Vasoconstriction as the etiology of hypercalcemia-induced seizures. Epilepsia 45 5 (2004) 551-554
68. Kline C.A., Esekogwu V.I., Henderson S.O., et al. Non-convulsive status epilepticus in a patient with hypocalcemia. J Emerg Med 16 5 (1998) 715-718
69. Mrowka M., Knake S., Klinge H., et al. Hypocalcemic generalised seizures as a manifestation of iatrogenic hypoparathyroidism months to years after thyroid surgery. Epileptic Disord 6 2 (2004) 85-87
70. Kossoff E.H., Silvia M.T., Maret A., et al. Neonatal hypocalcemic seizures: case report and literature review. J Child Neurol 17 3 (2002) 236-239
71. Langley W.F., and Mann D. Central nervous system magnesium deficiency. Arch Intern Med 151 3 (1991) 593-596
72. Shils M.E. Experimental human magnesium depletion. I. Clinical observations and blood chemistry alterations. Am J Clin Nutr 15 (1964) 133-143
73. Cevette M.J., Vormann J., and Franz K. Magnesium and hearing. J Am Acad Audiol 14 4 (2003) 202-212
74. Escalante C.P., Weiser M.A., and Finkel K. Hyperphosphatemia associated with phosphorus-containing laxatives in a patient with chronic renal insufficiency. Southampt Med J 90 2 (1997) 240-242
75. Hsu H.J., and Wu M.S. Extreme hyperphosphatemia and hypocalcemic coma associated with phosphate enema. Intern Med 47 7 (2008) 643-646
76. Marraffa J.M., Hui A., and Stork C.M. Severe hyperphosphatemia and hypocalcemia following the rectal administration of a phosphate-containing Fleet pediatric enema. Pediatr Emerg Care 20 7 (2004) 453-456
77. Knochel J.P. The pathophysiology and clinical characteristics of severe hypophosphatemia. Arch Intern Med 137 2 (1977) 203-220
78. Knochel J.P. Neuromuscular manifestations of electrolyte disorders. Am J Med 72 3 (1982) 521-535
79. Chudley A.E., Ninan A., and Young G.B. Neurologic signs and hypophosphatemia with total parenteral nutrition. Can Med Assoc J 125 6 (1981) 604-607
80. Aubier M., Murciano D., Lecocguic Y., et al. Effect of hypophosphatemia on diaphragmatic contractility in patients with acute respiratory failure. N Engl J Med 313 7 (1985) 420-424
81. Rie M.A. Hypophosphatemia and diaphragmatic contractility. N Engl J Med 314 8 (1986) 519-520
82. Kitabchi A.E., and Nyenwe E.A. Hyperglycemic crises in diabetes mellitus: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Endocrinol Metab Clin North Am 35 4 (2006) 725-751 viii
83. Carroll P., and Matz R. Uncontrolled diabetes mellitus in adults: experience in treating diabetic ketoacidosis and hyperosmolar nonketotic coma with low-dose insulin and a uniform treatment regimen. Diabetes Care 6 6 (1983) 579-585
84. Umpierrez G.E., Kelly J.P., Navarrete J.E., et al. Hyperglycemic crises in urban blacks. Arch Intern Med 157 6 (1997) 669-675
85. Kitabchi A.E., and Wall B.M. Diabetic ketoacidosis. Med Clin North Am 79 1 (1995) 9-37
86. Chu K., Kang D.W., Kim D.E., et al. Diffusion-weighted and gradient echo magnetic resonance findings of hemichorea-hemiballismus associated with diabetic hyperglycemia: a hyperviscosity syndrome?. Arch Neurol 59 3 (2002) 448-452
87. Lai P.H., Tien R.D., Chang M.H., et al. Chorea-ballismus with nonketotic hyperglycemia in primary diabetes mellitus. AJNR Am J Neuroradiol 17 6 (1996) 1057-1064
88. Raghavendra S., Ashalatha R., Thomas S.V., et al. Focal neuronal loss, reversible subcortical focal T2 hypointensity in seizures with a nonketotic hyperglycemic hyperosmolar state. Neuroradiology 49 4 (2007) 299-305
89. Singh B.M., and Strobos R.J. Epilepsia partialis continua associated with nonketotic hyperglycemia: clinical and biochemical profile of 21 patients. Ann Neurol 8 2 (1980) 155-160
90. Arieff A.I. Cerebral edema complicating nonketotic hyperosmolar coma. Miner Electrolyte Metab 12 5-6 (1986) 383-389
91. Arieff A.I., and Kleeman C.R. Studies on mechanisms of cerebral edema in diabetic comas. Effects of hyperglycemia and rapid lowering of plasma glucose in normal rabbits. J Clin Invest 52 3 (1973) 571-583
92. Van der Meulen J.A., Klip A., and Grinstein S. Possible mechanism for cerebral oedema in diabetic ketoacidosis. Lancet 2 8554 (1987) 306-308
93. Arieff A.I., and Kleeman C.R. Studies on mechanisms of cerebral edema in diabetic comas: effects of hyperglycemia and rapid lowering of plasma glucose in normal rabbits (J Clin Invest 52:571-83, 1973). J Am Soc Nephrol 11 9 (2000) 1776-1788
94. Pocecco M., and Ronfani L. Transient focal neurologic deficits associated with hypoglycaemia in children with insulin-dependent diabetes mellitus. Italian Collaborative Paediatric Diabetologic Group. Acta Paediatr 87 5 (1998) 542-544
95. Montgomery B.M., and Pinner C.A. Transient hypoglycemic hemiplegia. Arch Intern Med 114 (1964) 680-684
96. Malouf R., and Brust J.C. Hypoglycemia: causes, neurological manifestations, and outcome. Ann Neurol 17 5 (1985) 421-430
97. Foster J.W., and Hart R.G. Hypoglycemic hemiplegia: two cases and a clinical review. Stroke 18 5 (1987) 944-946
98. Agardh C.D., Rosen I., and Ryding E. Persistent vegetative state with high cerebral blood flow following profound hypoglycemia. Ann Neurol 14 4 (1983) 482-486
99. Tamburrano G., Lala A., Locuratolo N., et al. Electroencephalography and visually evoked potentials during moderate hypoglycemia. J Clin Endocrinol Metab 66 6 (1988) 1301-1306
100. Soltesz G., and Acsadi G. Association between diabetes, severe hypoglycaemia, and electroencephalographic abnormalities. Arch Dis Child 64 7 (1989) 992-996
101. Maruya J., Endoh H., Watanabe H., et al. Rapid improvement of diffusion-weighted imaging abnormalities after glucose infusion in hypoglycaemic coma. J Neurol Neurosurg Psychiatr 78 1 (2007) 102-103
102. Lo L., Tan A.C., Umapathi T., et al. Diffusion-weighted MR imaging in early diagnosis and prognosis of hypoglycemia. AJNR Am J Neuroradiol 27 6 (2006) 1222-1224
103. Finelli P.F. Diffusion-weighted MR in hypoglycemic coma. Neurology 57 5 (2001) 933
104. Bouillon R. Acute adrenal insufficiency. Endocrinol Metab Clin North Am 35 4 (2006) 767-775 ix
105. Calabrese L.H., and White C.S. Musculoskeletal manifestations of Addison's disease. Arthritis Rheum 22 5 (1979) 558
106. Abbas D.H., Schlagenhauff R.E., and Strong H.E. Polyradiculoneuropathy in Addison's disease. Case report and review of literature. Neurology 27 5 (1977) 494-495
107. Mor F., Green P., and Wysenbeek A.J. Myopathy in Addison's disease. Ann Rheum Dis 46 1 (1987) 81-83
108. Bremer A.A., Ranadive S., Conrad S.C., et al. Isolated adrenocorticotropic hormone deficiency presenting as an acute neurologic emergency in a peripubertal girl. J Pediatr Endocrinol Metab 21 8 (2008) 799-803
109. Arlt W., and Allolio B. Adrenal insufficiency. Lancet 361 9372 (2003) 1881-1893
110. Shulman D.I., Palmert M.R., and Kemp S.F. Adrenal insufficiency: still a cause of morbidity and death in childhood. Pediatrics 119 2 (2007) e484-e494
111. Devendra D., Walker A., MacFarlane I.A., et al. Confusion after visiting the radiology department. Lancet 350 9080 (1997) 780
112. Randeva H.S., Schoebel J., Byrne J., et al. Classical pituitary apoplexy: clinical features, management and outcome. Clin Endocrinol (Oxf) 51 2 (1999) 181-188
113. Noel N.E., and Ruthman J.C. Pituitary apoplexy presenting as monocular blindness. Ann Emerg Med 18 4 (1989) 414-417
114. Bonicki W., Kasperlik-Zaluska A., Koszewski W., et al. Pituitary apoplexy: endocrine, surgical and oncological emergency. Incidence, clinical course and treatment with reference to 799 cases of pituitary adenomas. Acta Neurochir (Wien) 120 3-4 (1993) 118-122
115. Vidal E., Cevallos R., Vidal J., et al. Twelve cases of pituitary apoplexy. Arch Intern Med 152 9 (1992) 1893-1899
116. Wartofsky L. Myxedema coma. Endocrinol Metab Clin North Am 35 4 (2006) 687-698 vii-viii
117. Jansen H.J., Doebe S.R., Louwerse E.S., et al. Status epilepticus caused by a myxoedema coma. Neth J Med 64 6 (2006) 202-205
118. Burch H.B., and Wartofsky L. Life-threatening thyrotoxicosis. Thyroid storm. Endocrinol Metab Clin North Am 22 2 (1993) 263-277
119. Nayak B., and Burman K. Thyrotoxicosis and thyroid storm. Endocrinol Metab Clin North Am 35 4 (2006) 663-686 vii
120. Pandit L., Shankar S.K., Gayathri N., et al. Acute thyrotoxic neuropathy-Basedow's paraplegia revisited. J Neurol Sci 155 2 (1998) 211-214