Central pontine myelinolysis medical therapy: Difference between revisions

Revision as of 23:58, 7 January 2020

Template:Central pontine myelinolysi Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR

The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Medical Therapy

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Disease Name

1 Stage 1 - Name of stage
- 1.1 Specific Organ system involved 1
  - 1.1.1 Adult
    - Preferred regimen (1): drug name 100 mg PO q12h for 10-21 days (Contraindications/specific instructions)
    - Preferred regimen (2): drug name 500 mg PO q8h for 14-21 days
    - Preferred regimen (3): drug name 500 mg q12h for 14-21 days
    - Alternative regimen (1): drug name 500 mg PO q6h for 7–10 days
    - Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
    - Alternative regimen (3): drug name 500 mg PO q6h for 14–21 days
  - 1.1.2 Pediatric
    - 1.1.2.1 (Specific population e.g. children < 8 years of age)
      - Preferred regimen (1): drug name 50 mg/kg PO per day q8h (maximum, 500 mg per dose)
      - Preferred regimen (2): drug name 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
      - Alternative regimen (1): drug name10 mg/kg PO q6h (maximum, 500 mg per day)
      - Alternative regimen (2): drug name 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
      - Alternative regimen (3): drug name 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
    - 1.1.2.2 (Specific population e.g. 'children < 8 years of age')
      - Preferred regimen (1): drug name 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
      - Alternative regimen (1): drug name 10 mg/kg PO q6h (maximum, 500 mg per day)
      - Alternative regimen (2): drug name 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
      - Alternative regimen (3): drug name 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
- 1.2 Specific Organ system involved 2
  - 1.2.1 Adult
    - Preferred regimen (1): drug name 500 mg PO q8h
  - 1.2.2 Pediatric
    - Preferred regimen (1): drug name 50 mg/kg/day PO q8h (maximum, 500 mg per dose)

2 Stage 2 - Name of stage
- 2.1 Specific Organ system involved 1
  Note (1):
  
  Note (2):
  
  Note (3):
  - 2.1.1 Adult
    - Parenteral regimen
      - Preferred regimen (1): drug name 2 g IV q24h for 14 (14–21) days
      - Alternative regimen (1): drug name 2 g IV q8h for 14 (14–21) days
      - Alternative regimen (2): drug name 18–24 MU/day IV q4h for 14 (14–21) days
    - Oral regimen
      - Preferred regimen (1): drug name 500 mg PO q8h for 14 (14–21) days
      - Preferred regimen (2): drug name 100 mg PO q12h for 14 (14–21) days
      - Preferred regimen (3): drug name 500 mg PO q12h for 14 (14–21) days
      - Alternative regimen (1): drug name 500 mg PO q6h for 7–10 days
      - Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
      - Alternative regimen (3):drug name 500 mg PO q6h for 14–21 days
  - 2.1.2 Pediatric
    - Parenteral regimen
      - Preferred regimen (1): drug name 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
      - Alternative regimen (1): drug name 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
      - Alternative regimen (2): drug name 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '(Contraindications/specific instructions)'
    - Oral regimen
      - Preferred regimen (1): drug name 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
      - Preferred regimen (2): drug name (for children aged ≥ 8 years) 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
      - Preferred regimen (3): drug name 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)
      - Alternative regimen (1): drug name 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)
      - Alternative regimen (2): drug name 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)
      - Alternative regimen (3): drug name 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)
- 2.2 'Other Organ system involved 2'
  Note (1):
  
  Note (2):
  
  Note (3):
  - 2.2.1 Adult
    - Parenteral regimen
      - Preferred regimen (1): drug name 2 g IV q24h for 14 (14–21) days
      - Alternative regimen (1): drug name 2 g IV q8h for 14 (14–21) days
      - Alternative regimen (2): drug name 18–24 MU/day IV q4h for 14 (14–21) days
    - Oral regimen
      - Preferred regimen (1): drug name 500 mg PO q8h for 14 (14–21) days
      - Preferred regimen (2): drug name 100 mg PO q12h for 14 (14–21) days
      - Preferred regimen (3): drug name 500 mg PO q12h for 14 (14–21) days
      - Alternative regimen (1): drug name 500 mg PO q6h for 7–10 days
      - Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
      - Alternative regimen (3):drug name 500 mg PO q6h for 14–21 days
  - 2.2.2 Pediatric
    - Parenteral regimen
      - Preferred regimen (1): drug name 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
      - Alternative regimen (1): drug name 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
      - Alternative regimen (2): drug name 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
    - Oral regimen
      - Preferred regimen (1): drug name 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
      - Preferred regimen (2): drug name 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
      - Preferred regimen (3): drug name 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)
      - Alternative regimen (1): drug name 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)
      - Alternative regimen (2): drug name 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)
      - Alternative regimen (3): drug name 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)

References

Template:WH Template:WS

@@ Line 1: / Line 1: @@
 __NOTOC__
-{{Central pontine myelinolysis}}
+{{Central pontine myelinolysi}}
-{{CMG}}
+{{CMG}}; {{AE}} {{MMJ}}
+==Overview==
+There is no treatment for [disease name]; the mainstay of therapy is supportive care.
+OR
+Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
+OR
+The majority of cases of [disease name] are self-limited and require only supportive care.
+OR
+[Disease name] is a medical emergency and requires prompt treatment.
+OR
+The mainstay of treatment for [disease name] is [therapy].
+OR
+The optimal therapy for [malignancy name] depends on the stage at diagnosis.
+OR
+[Therapy] is recommended among all patients who develop [disease name].
+OR
+Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
+OR
+Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
+OR
+Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
+OR
+Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
 ==Medical Therapy==
-To avoid myelinolysis, the correction of hyponatremia should not exceed 1 mEq/L per hour. <ref>Kleinschmidt-DeMasters BK, Norenberg MD. Rapid correction of hyponatremia causes demyelination: relation to central pontine myelinolysis. ''Science.'' 1981;211(4486):1068-70. PMID 7466381</ref><ref>Laureno R. Experimental pontine and extrapontine myelinolysis. ''Trans Am Neurol Assoc.'' 1980;105:354-8. PMID 7348981</ref>  There is no specific treatment and the syndrome is associated with high mortality and morbidity. This being a potentially avoidable disaster, following recommendations may be adhered to while maintaining sodium levels:
+*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
+*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
+*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
+*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
+===Disease Name===
-===Hyponatremia===
+* '''1 Stage 1 - Name of stage'''
-The rate of correction of [[hyponatremia]] should be 0.5-1.0meq/L/hr, with not more than a 12 meq/l correction in 24 hrs. If the patient has ongoing [[seizures]] (or [Na<sup>+</sup>]<115 meq/li), correction can be attempted at up to 2 meq/L/hr, but only while [[seizure activity]] lasts and the [Na<sup>+</sup>] exceeds 125-130 meq/Li.
+** 1.1 '''Specific Organ system involved 1'''
+*** 1.1.1 '''Adult'''
+**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)'''
+**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
+**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
+**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
+**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
+**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
+*** 1.1.2 '''Pediatric'''
+**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
+***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose)
+***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
+***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
+***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
+***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
+****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
+***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
+***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
+***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
+***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
+** 1.2 '''Specific Organ system involved 2'''
+*** 1.2.1 '''Adult'''
+**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
+*** 1.2.2  '''Pediatric'''
+**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
-===Hypernatremia===
+* 2 '''Stage 2 - Name of stage'''
-The rate of correction of [[hypernatremia]] should be at 0.5meq/L/hr and should not exceed 12 meq/Li/24hrs.
+** 2.1 '''Specific Organ system involved 1 '''
+**: '''Note (1):'''
+**: '''Note (2)''':
+**: '''Note (3):'''
+*** 2.1.1 '''Adult'''
+**** Parenteral regimen
+***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
+***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
+***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
+**** Oral regimen
+***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
+***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
+***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
+***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
+***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
+***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
+*** 2.1.2 '''Pediatric'''
+**** Parenteral regimen
+***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
+***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
+***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
+**** Oral regimen
+***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
+***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
+***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
+***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
+***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
+***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
+** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
+**: '''Note (1):'''
+**: '''Note (2)''':
+**: '''Note (3):'''
+*** 2.2.1 '''Adult'''
+**** Parenteral regimen
+***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
+***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
+***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
+**** Oral regimen
+***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
+***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
+***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
+***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
+***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
+***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
+*** 2.2.2 '''Pediatric'''
+**** Parenteral regimen
+***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
+***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
+***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
+**** Oral regimen
+***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
+***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
+***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
+***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
+***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
+***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
 ==References==
 {{Reflist|2}}
-[[Category:Disease]]
+{{WH}}
-[[Category:Neurology]]
+{{WS}}
-[[Category:Intensive care medicine]]
+[[Category: (name of the system)]]
-[[Category:Nephrology]]
-[[Category:Emergency medicine]]
-[[Category:Needs overview]]
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