Hyponatremia and Central Pontine Myelinolysis

What is hyponatremia? Information regarding CPM and EPM.

Archive for the tag “Central pontine myelinolysis”

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

Posted in What is Hyponatremia? and tagged , , , , ,
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.

Posted in What is Hyponatremia? and tagged , , ,
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

 

Posted in What is Hyponatremia? and tagged , , , ,

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