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Suggest Medication For Hyponatremia In A Diabetic

Posted on Thu, 19 Nov 2015

Question: Hi Doctor,

My father was diagnosed with Extra-Pontine Myelynolysis / osmotic demyelination after CABG and an episode of hyponatremia. He has also been diabetic for ~15 years.

The doctor here says it will just require long term care and not recommending any medicines, but I suspect my father would never be cured or may get worse. I have seen a lot of your papers and articles about treatment of the same.

He currently is bedridden, has strength in hands and sometimes is able to sit up on his own. He is not able to speak, sometimes speaks with a lot of difficulty. He recognizes us and can answer in yes/no when asked specific questions.

We are currently in a known hospital in XXXXXXX Can you please advise, what options do I have?

Answered by Dr. Sudhir Kumar (2 hours later)

Brief Answer:
IVIG therapy may help.

Detailed Answer:
Hi,

Thank you for posting your query.

I have noted your father's symptoms and current condition.

Extra-pontine myelinolysis (EPM) is a serious neurological disorder, usually caused by rapid correction of hyponatremia (low sodium level in blood).

EPM results in high rates of death as well as disability.

There are no proven treatments, however, IVIG (intravenous immunoglobulins) therapy has shown success in some patients with extra pontine as well as central pontine myelinolysis. I have used IVIG (Immunorel from Reliance) in three patients, and two of them showed improvement.

I hope this information helps.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (25 minutes later)

Thanks for the quick reply Doctor. Are there any other Physiotherapy and other things we could do to make things better for him, I see many patients online claiming to be recovering to be a little independant by rehabilitation.

I also understand the high rates of death and disability, how much time do you think we have before we can get some treatment for him to survive?

Is there anything that can be done other than IVIG?

Answered by Dr. Sudhir Kumar (15 minutes later)

Brief Answer:
Physiotherapy and rehabilitation are the manstays of treatment.

Detailed Answer:
Thank you for getting back.

Physiotherapy and rehabilitation are the keys to the treatment at this stage. A dedicated physiotherapist with three sessions of physiotherapy per day, cognitive stimulation, music therapy, active and passive limb movements are all important.

In addition, good nursing care, good nutrition by Ryle's tube/PEG tube feeding are also important.

Other than IVIG, there are no specific medications for this condition.

There is no time frame, but with every week of survival, the risk of death would reduce further. Disability would take several months to reduce.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (16 minutes later)

Thanks Doctor. Do you have a Doctor, Physiotherapist and Rehabilitation center to recommend?

Answered by Dr. Sudhir Kumar (22 minutes later)

Brief Answer:
Below are the recommendations

Detailed Answer:
Thank you for getting back.

I do not know any good physiotherapy/rehab centers in XXXXXXX However, the best center for rehab is at CMC, Vellore.

Regarding a neurologist, you can consult Dr Ichhaporia at XXXXXXX (probably at XXXXXXX hospital).

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar