Table 4

 Practical management strategy

CT, computed tomography; EPM, extra-pontine myelinolysis; MRI, magnetic resonance imaging.
• What sodium shifts have occurred?
• Confirm that the cause of hyponatraemia has been reliably established
• Is there the opportunity to reinduce hyponatraemia?
• Has imaging been done? In a ventilated patient CT is acceptable; MRI desirable; repeat imaging necessary if negative
• Is the patient “locked-in”? Do nursing and medical staff appreciate this? Do relatives understand?
• Are relatives “in the picture” re prognosis?
• If EPM present is dopaminergic treatment an option?