Neurologic Manifestations of Renal and Electrolyte Disorders

OBJECTIVE: This article reviews the clinical manifestations and treatment of the neurologic manifestations of renal and electrolyte disorders. LATEST DEVELOPMENTS: Osmotic demyelination caused by rapid correction of hyponatremia is now considered exceptionally rare, with studies calling into question current protocols that emphasize slow correction of hyponatremia. Patients with acute renal failure and encephalopathy may have posterior encephalopathy syndrome rather than uremic encephalopathy. Cefepime neurotoxicity in patients with renal failure is increasingly recognized. ESSENTIAL POINTS: Electrolyte disorders and uremia usually result in reversible cerebral dysfunction leading to encephalopathy, seizures, and muscle weakness. Hyponatremia is the only electrolyte abnormality associated with irreversible brain injury. Neuroimaging should be considered in patients with acute renal failure and encephalopathy to evaluate for posterior encephalopathy syndrome or subdural hematoma.