Hyponatremia and Central Pontine Myelinolysis

What is hyponatremia? Information regarding CPM and EPM.

CPM: THE STATISTICS

So after months of trying to find out the answers to this question, I have found a beginning answer. Now, here’s the thing. This is the diagnosis code for CPM, but it doesn’t include a diagnosis code for those who develop EPM only…at least I don’t believe it does. But, it’s a start. ūüôā

First the ICD-9 diagnosis code for CPM is

The way I found this is through my friend Jeffery Amitin. He left it in a message he posted in 2008. The ICD-10 code is G37.2:

2012 ICD-10-CM Diagnosis Code G37.2

Central pontine myelinolysis

  • G37.2¬†is a billable ICD-10-CM code that can be used to specify a diagnosis.
  • On October 1, 2013 ICD-10-CM will replace ICD-9-CM in the United States, therefore,¬†G37.2¬†and all ICD-10-CM diagnosis codes should only be used for training or planning purposes until then.

Mortality Data

  • Between 1999-2007 there were 209 deaths in the United States where ICD-10¬†G37.2¬†was indicated as the underlying cause of death¬†
  • ICD-10¬†G37.2¬†as underlying cause of death data broken down by: gender, age, race, year

ICD-10-CM G37.2 is part of Diagnostic Related Group(s) (MS-DRG v28.0):

  • 058¬†Multiple sclerosis & cerebellar ataxia with mcc
  • 059¬†Multiple sclerosis & cerebellar ataxia with cc
  • 060¬†Multiple sclerosis & cerebellar ataxia without cc/mcc

Convert ICD-10-CM G37.2 to ICD-9-CM

The following ICD-10-CM Index entries contain back-references to ICD-10-CM G37.2:

  • Myelinolysis, pontine, central¬†G37.2

Now, the above information states that the number of deaths related to CPM from 1999 to 2007 were 209 deaths. Now, I believe this is an EXTREMELY low number because it is believed that at least a 1/3 of patients who develop CPM die. The following information for 2010 ALONE, makes me doubt that the number of deaths related to CPM over an 8 year period is only 209.

2010 National statistics – principal diagnosis only

Outcomes by 341.8 Cns Demyelination Nec
341.8 Cns Demyelination Nec Standard errors
Total number of discharges 524 56
In-hospital deaths * *

The above information states that there were 524 DISCHARGES related to CPM…that doesn’t include the number of those who died from CPM.

The other interesting finding in the statistics above is that there WERE NOT ANY DEATHS related to CPM. Now, I really believe that’s not possible at all. Obviously, there’s information that is missing. ūüė¶

Now this makes a little more sense. If you list the number of diagnosis of CPM that is diagnosed in combination with another disorder/disease, then the number of those who impacted jumps dramatically:

2010 National statistics – all-listed
You have chosen all-listed diagnoses. The only possible measure for all-listed diagnoses is the number of discharges who received the diagnoses you selected. If you want to see statistics on length of stay or charges, go back and select “principal diagnosis.”
341.8 Cns Demyelination Nec
341.8 Cns Demyelination Nec Standard errors
Total number of discharges 2,490 190

The following chart is the number of those who have been diagnosed with CPM over the past 18 years. Considering that the number of cases of hyponatremia have increased over the past 10 years, it is a bit unusual not to see the same type of increase in the number of cases of CPM. Again, I have to wonder if the data reported on CPM, due to the nature that it is usually caused by malpractice, is in accurate. I will continue to try to find out information as it becomes available.

HCUPnet provides trend information for the 18 year period: 1993-2010

Number of discharges
ICD-9-CM all-listed diagnosis code and name 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
341.8 Cns Demyelination Nec 1,956 1,831 2,127 2,386 2,594 2,300 1,906 1,711 1,662 1,666 2,003 2,097 2,103 2,435 2,537 2,299 2,168 2,490

Keep in mind, that the above information is the number of people DISCHARGED. This is not a record of the number of deaths related to CPM.

Please use the following website to find out more information regarding CPM. You have to do research on all hospitals in the nation and use the ICD code 341.8 to locate these charts.

Also, please feel free to contact me with any questions.

 

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2 thoughts on “CPM: THE STATISTICS

  1. Excellent Blog, impressive research. I am a physician my self and CPM/EPM was something they always scared the pants off of us with in medical school when learning to rehydrate patients. The most common point we talked/learned about it was during the normalization process of Type One (insulin dependent) Diabetics, who for what could be many reasons had their sugars go extremely high and develop a condition known as Diabetic Ketoacidosis (DKA), where their blood chemistry goes out of whack, so does organ function and can be potentially very harmful and lethal. The patient can spend quite some time under close watch in the ICU during the course of treatment. It takes careful insulin/glucose level management, and lots and lots of fluid to achieve homeostasis (balance) again. This is one of the times you could put a patient at risk for CPM/EPM if not careful about the type and amount of fluid given. We use a series of calculations and very close monitoring to stay on top of it now. So if you need more stats for your research, look up CPM in relation to DKA, may have some interesting information.
    Great blog!

    • Thank you, Ninjadoc!!

      Prior to the CPM/EPM, I was preparing for the MCAT. Actually, I was expecting to take it in August of 2011, but I developed EPM in June 2011. Talk about a sudden change of events.

      Interestingly, I was told by all of the ICU staff, ALL of them, that the treatment would be slow and careful because it was extremely dangerous to raise my sodium levels too quickly. I have an Aunt and Uncle who are both MD’s, and they reinforced the same point.

      I thought because everyone seemed to be on the same page that I didn’t need to be concerned with the treatment.

      I was just so horribly sick that I didn’t question anything they were doing. I just wanted to feel better, and I thought that they knew what they were doing since they were aware of the consequences. Granted, I should have been in a coma or having seizures at that point because my sodium was 110 to 118, so I excuse myself of responsibility for their actions.

      The main doctor in charge, mishandled my care in three ways: he stopped monitoring my sodium for about 8 to 12 hours, at the same time that he had me on 3% sodium, and despite a rise from 110 to 118 on the IV alone, he decided to give me this “magic pill” that acted to raise my sodium even quicker…and he restricted my fluid intake at the same time. Considering my sodium levels were rising with just the Sodium IV, he should have avoided doing any of the other treatments.

      Further, I am certain that the doctors then realized that they raised it too quickly. They actually had the physical proof in that my sodium levels shot up to 143 or 144 within the 8 hours that they stopped monitoring it, and as soon as they got the levels, the nurse came in removed the sodium IV and put me on an isotonic solution. They started making me drink as much as possible.

      The next day, I started to develop a slight lazy eye. This was noticed by the new doctor that took over my care, but ignored. They also ignored my requests after I was released that there was something wrong. It took my driving to a larger hospital four hours away to get an exam and treatment for the CPM/EPM.

      I guess my point in all of that above, is that the doctors claimed the same. They all knew about it, but mistakes still happen. I think it’s really important for patients as well as doctors know and understand what can happen with hyponatremia. I had NO clue, and I had gone through all of my pre-med courses.

      Even more frustratingly, is that there is hardly any information available on CPM/EPM. There’s not any long term research. Granted, I don’t have access to every medical journal available, but the articles I have found seem to regurgitate information from previous articles. And it seems like a lot of speculation.

      I realize it is very rare. I mean if there is approximately 1.9 million people diagnosed with hyponatremia each year but only approximately 500-2000 with CPM/EPM, then I can’t expect every doctor to know or understand the complications related to it, but it would be great if there was at least one.

      Until I meet that doctor, I will do my absolute best to get all the information I find available to the public, and even better personal experience of those who do have it. Hopefully, it will make a difference ūüôā

      Thank you so much for your praise, and PLEASE send any feedback or information that you discover that you feel relates. I will look into the incidence of CPM/EPM in those being treated for ketoacidosis. It could be extremely scary to think that it might occur in relation to diabetes, considering the increasing number of those who are inflicted with it. SCARY!!!
      Thank you for your time!!

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