Hyponatremia and Central Pontine Myelinolysis

What is hyponatremia? Information regarding CPM and EPM.

Archive for the category “What is Hyponatremia?”

15 Dec 2011

Hyponatremia: treatments

This topic might take several days to compose because there is so so much to discuss regarding this.

I’m sure it’s not surprising to most that each type of cause of low sodium is unique, so the treatments will be unique as well. This is true to an extent, but I have a few universal key facts for everyone who is being treated for low sodium.

Please take note of these KEY Treatment facts, and then look at your specific cause of low sodium for additional treatment information.

1.) It is absolutely imperative that you limit your intake of water once you develop low sodium. Increasing your water levels while you are experiencing low blood sodium will further DECREASE/DILUTE your blood sodium. If your sodium levels increase with just fluid restriction, then there should be no further treatment needed.

I believe it is absolutely necessary to listen to your body while being treated for low sodium, so if you are on a fluid restriction, but at some point start to develop extreme thirst (not dry mouth but thirst), then you should listen to your body and consume more fluids. However, in some cases, there is a psychological disorder that makes a person drink extreme amounts of water, so in some cases, this would not be logical.

Fluid restrictions are common when being treated for hyponatremia, but my suggestion is to listen to your body if you develop thirst is  my opinion. It’s not a medical fact or medical suggestion. You will probably find the medical community does not agree.

Let me stress that fluids that do not contain sodium are extremely dangerous during this period, but consuming higher sodium fluids are fine, i.e. chicken or beef broths.

My opinion:

Might I even suggest diluting something like a fleet laxative. Fleet oral laxatives work because they are extremely high in sodium. Your body dumps EXCESS sodium through urine and the GI tract, and where sodium goes water follows. Typically, this causes the liquid stools that GI doctors require for a colonoscopy. However, if your body needs sodium, it will absorb the sodium through the GI tract and release the sodium it doesn’t need.

I have no medical research to back up my idea that using fleet or other sodium solutions will increase your sodium levels more effectively than IV saline solution. I will try to research this more and contact my GI doctors for their opinions in the future.

2.) IV saline of 3% is the typical starting treatment for hyponatremia. This is typically done in conjunction with water restriction. However, in some medical circles, it is believed that ONLY fluid restriction should be used. This is dependent upon the type of hyponatremia you have, as well as your starting sodium.

3.) A person’s blood sodium levels should be evaluated every 2 to 4 hours to prevent a rapid rise in sodium. (This should be done regardless of your starting sodium levels).

A rapid in rise of blood sodium levels can be catastrophic and lead to CPM/EPM, or death. I will discuss this topic in the future.

4.) If a person’s sodium level stabilizes while being treated with an IV saline solution of 3%,  no further treatment should be administered. In this case, stabilizing means that the levels do not decrease further, but remains the same or increases slightly over a 24 hour period.

5.) Prescription drugs like Samsca (tolvaptan) should NOT be used at the same time IV saline solutions are being administered. It is ABSOLUTELY dangerous to use IV saline solutions and most prescription drugs TOGETHER to treat hyponatremia. If a person you know or you are being treated for hyponatremia, be certain that you check the medications you are being given. The contradictions for these medications are typically found online.

A few of the oral prescription drugs used to treat hyponatremia:

Samsca Oral

sodium chloride Oral

tolvaptan Oral

5.) A 6 to 8 mmol/L increase in blood sodium concentration per every 24 hour period is the MOST a person’s sodium should be raised during a 24 hour period. ANYTHING greater than 6 to 8 mmol/L in a 24 hour consecutive frame is considered DANGEROUS!!!  Let me stress that it is a 24 hour consecutive time frame that needs to be considered. Do not consider a CALENDAR day as the 24 hour period. (Some studies suggested that an 10 to 12 mmol/L increase was acceptable, but most doctors now agree that 6 to 8 is the highest it should rise.) Let me stress: THE MOST your sodium level should rise is 6 to 8 mmol/L in a 24 hour period. Consider this point the RED zone. That means it is at this point that you are on the borderline of causing brain injury. The goal should be NOT to reach this RED zone because once your surpass these levels (which can be VERY difficult to control), you will be at high risk for brain injury.

Let me define how to classify a 24 hour period; if your levels were checked between 12 am, Jan 1st and 12 am Jan 2nd and your levels were only raised 5mmol/L, that is fine, but between 2pm Jan. 1st and Jan 2nd, your levels were raised 10 mmol/L, your levels were raised TOO much for a 24 hour consecutive period. A rapid correction of blood sodium levels can cause brain damage and/or death.

 I cannot think of any additional absolutes for the treatment for hyponatremia. These are the key treatment facts. 

Please be on guard if you are being treated for this condition. I will post tomorrow more on what I think are important ideas on the treatments for hyponatremia that are opinion based, but I will include  additional facts regarding specific treatments for the different causes of hyponatremia.

Please, pass this information forward. It might save your life or someone else’s.

 

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15 Dec 2011

Research and Links:

Technology is a magnificent thing, when it works. Today, I’m using my cellphone to start this post. It most definitely will need to be edited from my home PC. The reason: my laptop won’t allow me to connect to the internet. Frustratingly, I have no idea why, and I have spent most of last night and this afternoon trying to figure it out. Obviously, I haven’t, and after so much time fruitlessly invested, I’m at the moment restraining myself from stomping, throwing, and crushing it into 300-$1.00 pieces.

I should have realized that spending less on a laptop than a cellphone won’t buy you the best laptop on the market, but I really thought I would at least be able get online and write papers. Lesson learned.

Before I started the laptop rant, I was prepared to describe how long it takes me to write these brief posts. Before developing CPM, I could write approximately 3 full pages in 45 minutes. Now, I’m lucky if I can write 8 paragraphs in 2 to 3 hours. Now, that is frustrating!

Since developing CPM, my ability to communicate what I think clearly is significantly compromised. Some hours are better than others, but that also adds to my complete frustration. In this world,  you can’t call your employer and say, “I’m sorry. I’m not able to think through anything today. I won’t be coming to work. Maybe tomorrow.” Obviously, the world doesn’t work that way. It can’t.

Let me stress that, I don’t believe my intelligence has been impacted but my ability to recall information but the ability to communicate my thoughts have. It’s extremely stressful when you can’t say what you feel. At times, when I am under significant stress, I have been reduced to monotone grunts and sputters.  That’s not an exaggeration. I make absolutely no sense.

Ok, so I’ve gone on several rants and haven’t relayed any facts, and that’s really what I want to focus on right now.

I want to start posting some of the links that you can access some of the information I have. I am attaching links for the Toronto study from PubMed, http://www.ncbi.nlm.nih.gov/pubmed/20142578.  This study is pretty recent, Feb. of 2010.

At this time, I still haven’t received any word from any of the local hospitals from which I requested their hyponatremia statistics. I’m not really surprised, but I will try again tomorrow.

Regarding sports athletes:

http://www.ux1.eiu.edu/~cfje/4900EN/GSSI-88-hyponatremia.pdf

The following link is in regards to a study performed on the 2002 Boston Marathon Runners.  Thirteen percent of 488 participants developed severe hyponatremia. Wow, right?!!

http://www.nejm.org/doi/full/10.1056/NEJMoa043901

Another marathon study for hyponatermia. This was also a 2002 study done by University of Pittsburgh:

http://www.ncbi.nlm.nih.gov/pubmed/11828223

A recent study, June 2011, regarding hyponatremia and antidepressants. I really didn’t know that antidepressants would cause hyponatremia, so this study took me by surprise. I know A LOT of people who take antidepressants. It’s actually the most commonly prescribed class of drugs. This is really scary.

http://www.psychweekly.com/aspx/article/articledetail.aspx?articleid=1302

The risk in the Elderly:

http://www.inaactamedica.org/archives/2011/21979280.pdf

I found this article, EXTREMELY interesting. It’s a September 2011 interview with the vice president (a doctor) of a hospital consulting company:

http://mdmag.hcplive.com/publications/hospital-medicine/2011/August-2011/Hyponatremia-A-Hospitalists-Perspective

Hyponatremia and it’s impact on children:

http://www.indianpediatrics.net/dec2000/dec-1348-1353.htm

Hyponatremia and Alcoholics. I also wanted to let you know, it frequently occurs in drug addicts as well:

http://alcalc.oxfordjournals.org/content/35/6/612.full

I am going to pull important information from the following link. I think it really puts into perspective, how alcohol impacts blood sodium levels:

http://findarticles.com/p/articles/mi_m0847/is_n3_v13/ai_8193360/

Alcohol consumption can have pharmacological effects on water and sodium metabolism. The effects of alcohol on sodium and water balance may differ with acute alcohol intake, chronic alcohol intake, or acute withdrawal from chronic alcohol abuse.

As the blood alcohol level rises with acute alcohol intake, a transitory increase in the elimination of “free water” (water without salts) by the kidney occurs (Rubini et al. 1955), resulting from inhibition of the release of antidiuretic hormone (ADH). As the plasma alcohol level decreases, urinary flow is reduced (Nicholson and Taylor 1938). Concomitant stimulation of water intake (Sargent et al. 1978) causes significant water gain. This water retention occurs together with sodium retention (Nicholson and Taylor 1938; Sargent et al. 1978) due to increases in the reabsorption of sodium by the kidney.

Animal studies involving chronic alcohol intake have shown significant retention of water, sodium, potassium, and chloride after the first week of daily alcohol ingestion (Beard and Knott 1968). Urine output does not decrease, but fluid ingestion is stimulated.

During acute withdrawal following chronic alcohol abuse, urinary elimination of sodium, chloride, and water increases (Beard and Knott 1968). The augmented urinary flow eliminates the fluid and electrolytes that were retained in excess during alcohol abuse.

I hope this post emphasizes the fact that at some point nearly EVERYONE will develop hyponatremia. I hope that listing these links, you may realize, I am not over exaggerating anything.

I believe it is absolutely fundamental that everyone is educated on the risk factors and what the proper treatment is. Tomorrow, I promise, I will explain everything I know about how hyponatremia should be treated. I will also provide my best insights on how some treatments may induce CPM, and what I believe would be extremely important considerations to discuss with your doctor if you are being treated for it.

 

UPDATE: 04/20/12—-I just wanted to include this link. It’s a link for Tufts Medical School. It outlines what happens in hyponatremia. It gives a great explanation for the medical aspects of hyponatremia. I would consider this a really great condensed version of things I’ve written about so far: http://ocw.tufts.edu/data/33/497472.pdf

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13 Dec 2011
2 Comments

More to the Story:

Last night, I couldn’t sleep. For some reason, I thought thinking about what I would post today would allow me to fall into slumber. Not that I think my posts are boring ;), but I thought concentrating on something I was going to do would soothe me. Ha, I was so wrong!!

Normally, I don’t have a problem falling asleep, but I have a horrible time staying asleep. I wake up about 10 to 13 times a night! Really, I don’t know what the purpose of my trying to sleep is. It doesn’t work. But, in an effort to fix this problem and to relieve my utter exhaustion, I started using Ambien last week.

Anyone who has used Ambien will tell you, its effectiveness doesn’t last long. After a few peaceful nights of only waking 3 or 4 times per night, I feel more rested, but I only get that effect for the first 2 or 3 days. After that, I start waking up more and more again, so I try to use it for short periods. I will use it for a few days, maybe a week and then stop. I know if I keep using it, it won’t do any good at all after two weeks or so, but if I use it, then stop, in a week or so, I can use it again and have it work for a few nights or so. At least, I’ll have a few “good” nights of sleep.

So, last night, I had an Ambien free night, and that led to insomnia, which is a problem that I don’t have very often. I simply could not fall asleep, and when I did, I had horrible dreams along with waking up every 20 to 45 minutes.

Getting back to my point, I thought thinking about my hyponatremia story would soothe me into slumber. Of course, it didn’t. I became so upset with how my treatment was handled, and how I developed EPM because of it that I had to concentrate on not thinking about it.

If I start talking about what happened to me that will be the end of my spreading the word of how to prevent it. I will, at some point in the near future, start discussing what happened to me and how it’s impacted my life. I definitely encourage anyone who is experiencing their own incidence of hyponatremia to post their stories. Please post your story! Post any information you might feel that I have missed because I know I am missing things, which leads me to what I am going to focus on right now.

In my post yesterday, I forgot to mention a few important groups of people that are susceptible to hyponatremia.

I can’t believe I didn’t include this yesterday, but persons who have brain tumors (especially those of the pituitary gland), and those persons who have had brain surgery have an increased chance of developing hyponatremia. (I really can’t believe I forgot this group yesterday because this is the group that I am in!!)

So, the pituitary gland (located in the brain) is the master gland. It produces hormones that control additional hormones through out the body. I don’t want to delve into a tremendous amount of detail about the pituitary gland. The most important thing to know is that it is responsible for the hormone, ADH.

ADH, is one of the hormones that controls the amount of fluid the body holds on to. If ADH is not produced or too little is produced, a person will pee constantly. This leads to an issue known as diabetes insipidus.

Okay, so most people will think…wait, diabetes has to do with blood sugar, and I’ve never had that problem. This isn’t entirely correct.

Diabetes by definition is a metabolic disorder that causes excessive thirst and excessive urination. There are several types of diabetes. The most commonly known type of  diabetes is diabetes mellitus.

Mellitus is Latin for sweet. So, diabetes mellitus is translated to mean “Sweet Urine”. This is because doctors used to taste the urine of patients to determine whether or not they had an issue with their pancreas. (Now, you know why they were paid so much money. You would have to pay me A LOT to drink someone’s urine. Just saying.) They knew that the issue was with the pancreas if the urine was sweet because the excess  sugar would be dumped from the body through the urine.

The type of diabetes that leads to hyponatremia is usually diabetes inspidus. Insipidus means tasteless in Latin. So a person with diabetes insipidus would produce a large amount of  dilute tasteless urine. This issue is most commonly caused by an issue with the pituitary gland.  The pituitary gland stops producing the hormone, ADH, so a person releases a large amount of urine.

I hope that all makes sense.

Moving forward, another important group I didn’t mention yesterday, are people who are starting antidepressants. During the first few weeks of starting an antidepressant, a person has a high incidence of developing hyponatremia. I’m guessing since antidepressants impact brain chemistry (usually seratonin uptake inhibitors), in some people it impacts pituitary function as well. This is totally a guess, so don’t quote me on that.

A few additional groups that frequently develop it: persons with AIDS, pneumonia (or severe respiratory issues), and burn victims.

Finally, I mentioned that liver disease increases hyponatremia, but I wanted to specify that cirrhosis of the liver increases your chance of developing hyponatremia.

I think this really emphasizes the point of it’s not a matter of who, but WHEN will you develop hyponatremia, and the seriousness of hyponatremia should be addressed. It’s extremely dangerous. It’s not uncommon and most people have never even heard of it. The more scary part is: if your doctor doesn’t treat it properly, you can die, end up a living vegetable, or with brain damage.

I hope that I can prevent that from happening to someone, and I greatly appreciate if you are reading this that you will help spread the word by posting this information to your Facebook page, or sending the information directly to your friends. You really might save a life!!

 

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12 Dec 2011

The Facts Continued: Who is impacted

Even though it is 1pm, my hours are so screwy that this is like 8am to me. So, if my thoughts are a bit jumbled this is why.

Today, I wanted to discuss WHO gets hyponatremia. This information was startling when I first read about it because it really isn’t a matter of who will get it but WHEN.

I already posted previously a research study regarding a Toronto, Canada hospital that found 38% of patients were admitted for hyponatremia and another 38% develop hyponatremia if they are hospitalized longer than a day. Shocking.

I am currently trying to obtain information from my local hospitals about the number of patients that are admitted or develop hyponatremia each year. Of course, I’m meeting obstacles in obtaining this information. No one seems to know who to contact, but if I ever receive the information, I will be certain to post it.

So who is impacted by hyponatremia, who are the people most at risk?

It can occur in persons who have the flu due to vomiting and diarrhea (also with bulimics).

Those who are athletes (esp. marathon runners). I want to stress that it is not uncommon for athletes to be misdiagnosed with heat stroke or dehydration when it is actually hyponatremia. This is really scary because the hospitals will treat these patients with fluids and the increase of fluids will actually drop their sodium levels further!!!! Please if you are ever in a situation in which you have just completed vigorous, long lasting activities, and you develop the symptoms of hyponatremia, be certain they check your sodium levels before they administer fluids!!!

Chemotherapy recipients are also at an additional risk. Now, this information comes from my ICU nurse that treated me. I honestly can’t remember her name, but she explained to me that they will get chemotherapy patients who develop low sodium levels because they are not able to handle eating or drinking without vomiting. She said it happened frequently.

Alcoholics who are quitting “cold turkey” are at extremely high risk for developing hyponatremia, and further more they are at even greater risk for developing CPM. I know several people who developed CPM that were former alcoholics. It seems to be that it isn’t when they consume large amounts of alcohol that causes the problem, but when they are “drying out”.

I really think more research needs to be done on this.It would be interesting to find out if developing hangovers have anything to do with hyponatremia.

Alcohol impacts the hormone, ADH (anti-diuretic hormone) which is released from your pituitary. ADH controls your fluid out put, i.e. how much you pee. Alcohol decreases the amount of ADH released from the pituitary which signals to the kidney’s that you are going to release more sodium from your system. Where sodium goes, water follows. Drinking alcohol causes you to pee a lot. I’ve been told that this causes your brain to shrink due to dehydration and you develop headaches. However, this would contradict what is known to happen when sodium levels drop. When blood sodium levels drop, your brain cells swell, and one of the major symptoms of hyponatremia is severe headache. Interesting, right?

Obviously, research really needs to be done to understand why people get hangovers but also the relationship between low sodium and persons who consume vast amounts of alcohol.

Moving on…

Persons who drink large volumes of water are also at an extremely high risk for hyponatremia. Let me stress that water is dangerous if you consume too much. I think, it’s called water toxicity. You dilute your blood electrolyte levels to a non-functioning capacity. This is why if you participate in vigorous training, exercise, running, swimming, etc, you should consume a product like Gatorade or even sodas (but I highly recommend sports drinks because they not only have sodium but other electrolytes like potassium). There is a certain type of psychological disorder where people consume large amounts of water. These persons are at frequent risk for hyponatremia.

It can also be caused by certain blood pressure medications (diuretics) can induce hyponatremia. Here’s the really scary thing regarding this, you might be on the diuretic for Years and never have an issue, but then one day, with no warning, it causes you to develop hyponatremia.

My GP described an incidence of this with one of his older patients. The person had been taking a certain diuretic blood pressure medication for over TEN years, and then one day developed severe hyponatremia!!! The only determined cause was her BP medication.

There is strong incidence of persons who have heart failure, kidney disease, and liver disease to develop low sodium.

The elderly and the very young are also at great risk. Isn’t that the case with everything?

(Addendum: I recently found out from my local children’s hospital that it is pretty common and devastating for infants. They develop hyponatremia because in this depressed economy families are watering down formula to conserve costs. The watering down effects impacts the electrolyte balances in infants and leads to hyponatremia. It was mentioned that this is a huge issues in Kentucky. I’ve raised two children. One of which received infants formula, I had no idea that this was potential threat. I am so relieved that I was never in the position where I had to dilute formula to save money, but I am certain this occurs a lot. The representative also warned that if an infant or child developed hyponatremia, they were at greater risk for death or brain damage. It was not stated if this was because of CPM/EPM or hyponatremia itself. If you or someone you loved is in this situation, please inform them of this risk! ).

So, at this point, you might be wondering who DOESN’T have a high risk for hyponatremia? That is precisely my point. Hyponatermia is very common, and it is absolutely necessary for people to become more aware of this condition and the proper treatment.

If you are in one of the higher risk categories, take a few minutes to read about the symptoms, how it should be treated, and then pass it on. Make other people aware of it, and SAVE A LIFE 🙂

Some basic symptoms of hyponatremia: Muscle cramps, severe headache, nausea, fatigue, vomiting, confusion, delirium, hallucinations, and coma.

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11 Dec 2011

Hyponatremia: More Facts

Hyponatremia is the most common metabolic disorder. This fact comes from PubMed and other research articles.

What is Hyponatremia? It is blood sodium levels of 135 mEq/L or less. The normal range for blood sodium is 135 to 145 mEq/L.

It sounds pretty innocent in nature. Just consume a little more salt, and you should be fine, right?

It really isn’t that simple. Once your sodium levels drops below 135mEq/L, your brain cells begin to swell with fluid. The swelling of your brain cells causes severe headache, nausea, fatigue, vomiting, confusion, delirium, hallucinations, and coma. Of course, it can also lead to death. One of the other symptoms it causes is cramping. Sodium is an important electrolyte in the regulation of muscle contraction, so when it drops below normal your muscles experience hyper contractility.

So that sounds a little bit more scary, right? No one wants brain swelling.

That’s true, but the really scary thing is how frequently it occurs and who it effects.

One study showed that 38% of hospital admissions were due to hyponatremia. You might not be great with math, but that’s almost half. That figure was the number of people being sent to the hospital due to hyponatremia. An even scarier number, is that 38% of patients who were hospitalized experienced hyponatremia if their hospital stay was longer than ONE day. This study was found on PubMed and was done at St. Michael’s Hospital in Toronto, Canada. The study was performed by the University of Toledo.

In the United States, there are by far, fewer studies being performed for hyponatremia, and the consequences of improper treatment. The main reason, in my opinion, is because the consequences of improper treatment can be significant brain damage, coma, death and/or a permanent paralyzed state known as, locked-in syndrome. This injury is known as CPM/EPM, and it is 100% caused by medical malpractice. (Okay, I have to add an addendum to this. In most cases, CPM/EPM is caused by the error of raising sodium levels too quickly; however, there have been additional studies that suggest that CPM/EPM can be associated with  disorders other than hyponatremia. It is known to happen without hyponatremia in cases of alcoholism, liver transplants, certain lung cancer treatments, leukemia, brain injuries and other transplants. The information regarding these other causes of CPM/EPM are fairly uncommon (except in the case of alcoholics which can be as high as 30% incidence of spontaneous causal).

CPM/EPM is caused when a person’s sodium levels are raised too quickly. This drastic increase causes the previous swollen brain cells to rapidly shrink. The shrinking causes neurons (nerve cells) to be stripped of their myelin.

So, this is the second post that I’ve mentioned myelin, and you may or may not understand the significance of it, so let me explain a little more about it.

Myelin is a fatty white sheath surrounding the axons of nerve cells. It coats the cells. Compare it to an electrical cord. Because my parent’s had an ancient vacuum cleaner, I’m going to use it in this description.

My parent’s Kirby vacuum cleaner was purchased when they were first married. Being the devious and creative children that my brothers and I were, we played extensively with the vacuum cleaner. We would unwind the cord and pretend that it was a rope which we used to cross canyons. We used it as a whip, as a lasso, as a tightrope, a jump rope. The possibilities were endless. Is it any real big surprise then, that this poor cord began to fray and wear. In certain places, the plastic coating surrounding the conducting wires became completely worn away. I actually think my older brother would use the vacuum cord as a chew “toy”. Of course, this happened only when it was unplugged, but you get the idea.

Eventually, the frays in the cord made it difficult (probably even a bit dangerous) to operate. In order to get a current from the electrical outlet to the vacuum motor, the cord would have to be kinked in certain ways. Some times this was effective and the vacuum would work. Other times, the only thing that would happen is you would receive a healthy shock.

Myelin is the in much regards comparable to the sheath that insulates the wires to the vacuum. It allows the current in the wires to travel unmolested from the electrical outlet to the motor. When the cord became damaged, the current could travel to the motor or it could take an alternate path to the hand of the user. Myelin allows the current from the cell body (consider it the electrical outlet) of a neuron to the terminal ends (called axon terminals) rapidly and in the correct direction. There are millions of cells in your brain that don’t have myelin (grey matter). These cells function perfectly fine without this coating. However, the signals that travel these cells move at a considerably slower rate.

If a nerve cell has a myelin sheath, the transmission of signals is more rapid than those without myelin. This might explain why when the myelin sheath is injured, such as in Parkinson’s Disease and CPM/EPM, a person can experience halted, jerky movements.

In closing for today, CPM/EPM is the disorder that is demyelination caused by the rapid swelling and shrinking of brain cells. The rapid swelling occurs because the sodium drops below normal. The rapid shrinking occurs when the blood sodium levels are increased too quickly. The impact this has is hundreds of thousands of short circuits in the wiring of the brain.

I hope this is understandable. Please leave posts with questions, and I will try my best to answer them.

 

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11 Dec 2011

Hyponatremia: The Facts

Hyponatremia is the most common diagnosed metabolic disorder. It occurs in approximately 38% of people who are hospitalized. That’s a pretty substantial number. I am one of the approximate 1.6 million people who developed it in 2011.

I am determined to bring this disorder to light, and I am more determined to bring awareness to Central Pontine Myelinolysis. CPM is a demyelination of the pontine area. It is also common for the demyelination to occur outside of the pontine area. This is known as extra pontine myelinolysis. Myelin is a sheath surrounding nerve cells. myelin creates a white appearance to nerve cells. This area in the brain is known as white matter. Grey areas are parts of the brain that do not have myelin.

The incorrect treatment of hyponatremia can cause CPM/EPM.

I will continue to post facts and statistics regarding hyponatremia and CPM. Also, I will post my personal story regarding my issues with CPM/EPM. I hope the facts and my story can prevent future persons from developing these conditions.

God Bless

 

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