Central pontine myelinolysis sodium concentration. Three to five days later, a second phase of neurological manifestations occurs correlating with the onset of myelinolysis. Observable immediate precursors may include seizures, disturbed consciousness, gait changes, and decrease or cessation of respiratory function. The classical clinical presentation is the progressive development of spastic quadriparesis, pseudobulbar palsy, and emotional lability (pseudobulbar affect), with other more variable neurological features associated with brainstem damage. These result from a rapid myelinolysis of the corticobulbar and corticospinal tracts in the brainstem. The most common cause is overly rapid correction of low blood sodium levels (hyponatremia). Apart from rapid correction of hyponatraemia,
Human serum albumin trauma, burns and surgery patients. A Cochrane systematic review of 37 trials found no evidence that albumin, compared with cheaper alternatives such as saline, reduces the risk of dying. Human serum albumin has been used as a component of a frailty index. It has not been shown to give better results than other fluids when used simply to replace volume, but is frequently used in conditions where loss of albumin is a major problem, such as liver disease with ascites. Human serum albumin may be used to potentially reverse drug/chemical toxicity by binding to free drug/agent. (Tatlow, D, Poothencheri, S,