Central Pontine Myelinolysis Lawsuit: Verdicts, Caps, and Proof

A central pontine myelinolysis lawsuit is a medical malpractice claim brought when a hospital or clinician corrects a patient’s low blood sodium too quickly, causing catastrophic and usually permanent brain injury. These cases have produced verdicts ranging from several million dollars to nearly $70 million, though the final recovery depends heavily on the state, the facts, and whether damage caps apply.

The condition — also called osmotic demyelination syndrome — is widely treated as preventable in the medical literature. Guidelines call for sodium to rise no more than roughly 8 to 12 milliequivalents per liter over 24 hours. Exceed that, and the resulting damage can leave a patient with locked-in syndrome, spastic quadriplegia, swallowing and speech deficits, seizures, cognitive impairment, or coma. Only 25 to 40 percent of patients recover without significant lasting deficits, and roughly a quarter remain permanently incapacitated.¹ That combination — a well-known safe rate and a devastating, irreversible outcome when it’s ignored — is what drives the litigation.

What Plaintiffs Allege Went Wrong

CPM claims argue that healthcare providers deviated from an accepted standard of care. The specific failures fall into a few recurring patterns.

Sodium Given Too Fast

The most common allegation is that providers raised sodium at a rate far exceeding safe limits. In one Pennsylvania case, a nurse delivered a full liter of sodium in under an hour when the physician had ordered 125 cc per hour, and the patient’s sodium spiked by 23 milliequivalents — roughly double the maximum 24-hour limit.² In a Nevada case, the patient’s sodium was raised by more than 17 points in 24 hours, well above the recommended maximum of eight.³

Failure to Monitor

Even when the initial order is appropriate, claims arise when providers fail to check sodium levels often enough. Nursing staff are expected to re-test sodium several times a day and relay results back to the treating physician so the rate can be adjusted before it overshoots.⁴

Failure to Rescue

Medical literature recognizes a rescue protocol when sodium rises too fast: desmopressin combined with a dextrose solution to bring levels back down. Overcorrection is treated as an emergency requiring immediate action.⁵ Not deploying that intervention when sodium has already exceeded safe thresholds can support a separate negligence theory.

Institutional Failures

Some suits target the hospital itself. Allegations include failing to use infusion pumps that would regulate sodium delivery, not requiring two-nurse verification for high-alert medications like concentrated saline, tolerating illegible physician orders, and lacking sodium-monitoring protocols altogether.²

What CPM Cases Have Been Worth

Because the injuries are severe and the standard of care well-established, juries have assigned substantial damages when the evidence supports negligence.

$68.6 million (Florida, 2022). In Crohan v. University Community Hospital, Inc., a jury in Florida’s 13th Circuit Court awarded $68,635,397 to Miranda Crohan, who suffered catastrophic brain damage after her sodium was overcorrected during treatment for hyponatremia related to a rare form of diabetes. Plaintiff’s counsel argued the physicians raised sodium “far too quickly” without understanding the cause of the imbalance. The jury apportioned 85% of fault to one critical care physician, with smaller shares to three other doctors. The defense’s competing theory — that autoimmune encephalitis caused the brain damage — was rejected.⁶

$47 million (Nevada, 2023). A Clark County jury found multiple providers negligent in the care of Amy Geiler, awarding roughly $47 million — including $10 million for future medical expenses and $28 million for future pain and suffering. Nevada’s malpractice cap then reduced the $35 million in noneconomic damages to $350,000.³

$14.9 million settlement (Illinois). An Illinois woman settled for $14.9 million after her endocrinologist, nephrologist, and hospital failed to monitor critically elevated sodium tied to diabetes insipidus. She lapsed into a coma and was diagnosed with permanent brain damage from metabolic acidosis and CPM, and now requires round-the-clock nursing care.⁷

$6.5 million (Connecticut, 2013). In Estate of Jeffrey Pattison v. Danbury Hospital, a jury awarded $6.5 million in a wrongful death suit after a 44-year-old man died from CPM. Pattison was admitted March 1, 2006, with low sodium; an ICU doctor raised his levels too quickly within the first 12 hours, and overcorrection continued during his two-week stay. He died March 16, 2006, after life support was withdrawn. The award included $3 million for pain and suffering, $3 million for loss of enjoyment of life, and $500,000 for the death itself.⁸

$5 million (Pennsylvania). A jury in Pennsylvania’s Allegheny County Court of Common Pleas found the hospital fully liable, returning a $5,003,000 verdict after the nurse-administered rate error described above.² A separate Illinois case with similar facts also ended in a $5 million verdict after a one-week trial.⁹

When the Defense Wins

Not every CPM suit succeeds. In November 2024, a New York-area court granted summary judgment dismissing a case against a physician assistant, an emergency medicine attending, a hospitalist, and an intensivist accused of mishandling hyponatremia in a 60-year-old patient who died from CPM. The plaintiff had sought more than $5 million. The defense presented expert testimony in emergency medicine, internal medicine, nephrology, and critical care, and the court concluded that care had been timely and appropriate, including proper normal saline administration and coordination with a nephrology specialist. The dismissal was with prejudice.¹⁰

Common defense arguments are that the correction rate stayed within acceptable bounds, that the clinical team followed protocol, or that an underlying condition caused the brain injury rather than the treatment.

How State Damage Caps Change the Recovery

The state where the case is tried can matter as much as the facts. The Geiler case illustrates the point: a jury valued her injuries at $47 million, but Nevada’s cap on noneconomic damages cut the pain-and-suffering component from $35 million to $350,000.³

Roughly 24 states cap noneconomic damages in medical malpractice cases, and six impose caps on total damages including economic losses.¹¹ Pennsylvania, Connecticut, New York, and Florida have no caps, which helps explain why some of the largest CPM verdicts have come from those states. Where caps apply, plaintiffs’ attorneys often build the case around economic damages such as lifetime care costs, since those categories may not be subject to the same limits.

What You Can Recover

Damages in successful CPM cases have covered:

Past and future medical expenses. In Geiler, the jury awarded $1.4 million for past medical costs and $10 million for future medical care.³
Lifelong nursing care, which can run into the hundreds of thousands of dollars annually for patients who need round-the-clock assistance.⁷
Lost wages and lost earning capacity.
Pain and suffering. In the Pattison wrongful death case, this component alone was $3 million.⁸
Loss of enjoyment of life. The Pattison jury separately awarded $3 million under this category, calculated in part on a 30-year life expectancy.¹²
Wrongful death damages when the patient dies, including compensation for losses to surviving family members.

Who Can Sue and How Long You Have

The injured patient can bring the claim. If the patient has died, the estate or surviving family members can sue for wrongful death, as in the Pattison case and the 2024 New York dismissal.

Statutes of limitations for medical malpractice vary by state and are generally two to three years. Some states apply a discovery rule that starts the clock when the patient knew or should have known about the injury rather than the date of the negligent treatment. Missouri, for example, imposes a two-year deadline from the act of negligence, with a hard 10-year outer limit regardless of when the injury was discovered; minors there have until their 20th birthday to file.¹³ Missing the applicable deadline typically bars the claim permanently.

Hospital or Physician — Who Pays

CPM suits often name both the treating physicians and the hospital, and juries apportion fault based on the facts. In one New Jersey case, a jury assigned 60% of fault to a critical care physician and 40% to a nurse.¹⁴ In the Pennsylvania case, the hospital itself was found fully liable, with the court focusing on the absence of infusion pumps and verification protocols.² In Crohan, the verdict fell entirely on four individual physicians.⁶

Nursing negligence is a distinct pathway to hospital liability. When a nurse administers sodium at a rate different from the physician’s order, skips the infusion pump, or does not report rising lab values to the doctor, the hospital may be directly liable for the nursing error and for failing to maintain systems that would have caught it.

What It Takes to Prove the Case

CPM cases are medically complex and turn on expert testimony from fields like nephrology, neurology, critical care, and internal medicine. Experts establish what the standard of care required and then show whether the defendants met or fell short of it. Medical records documenting the timeline of sodium levels, medication orders, and nursing notes are the evidentiary backbone. MRI imaging is typically used as diagnostic confirmation. In the Crohan trial, plaintiff’s counsel framed the standard as a single memorable principle for the jury: “If you don’t know, go slow.”¹⁵

1
National Center for Biotechnology Information. Central Pontine Myelinolysis
2
Clinician.com. Legal Review: Hospital’s Negligent Administration of Sodium Results in Brain Damage
3
Claggett & Sykes Trial Lawyers. Amy Geiler Won Her Medical Malpractice Case. She Still Won’t See True Justice
4
Painter Law Firm. Dangerous Low Sodium Needs Prompt and Proper Medical Care
5
JSciMed Central. Prevention and Treatment of the Osmotic Demyelination Syndrome: A Review
6
Courtroom View Network. Jury Awards $68.6M in Med Mal Trial Over Woman’s Profound Brain Injury Following Sodium Imbalance
7
Maryland Medical Malpractice Attorney. Failure to Monitor Sodium Levels Leads to Permanent Brain Injury
8
Hartford Courant. Jury Awards $6.5 Million to Family of Man Who Died at Danbury Hospital
9
PA Medical Malpractice. Hyponatremia Medical Malpractice Lawsuit
10
Shaub, Ahmuty, Citrin & Spratt LLP. Summary Judgment Dismissal in CPM Case
11
Center for Justice & Democracy. Fact Sheet: Caps on Compensatory Damages, State Law Summary
12
Koskoff Koskoff & Bieder. Improper Sodium Treatment Leads to $6.5 Million Verdict Against Danbury Hospital
13
Missouri Revisor of Statutes. RSMo Section 516.105
14
Medical Malpractice Lawyers. New Jersey Medical Malpractice Verdict Due to Hospital Negligence
15
Courtroom View Network. How Simplifying Complex Medical Concepts Helped Set Up $68.6M Verdict