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What Causes Drowsiness And Restlessness?
Question: Dear Doctor
Request for your advice on following.
Background
My mother is 67 years old. She is diabetic (type 2). In 2008 she was detected with multiple blockages in heart and had a undergone bypass surgery in 2008. She was on allopathic medicines since then.
For last 2 years she had to be admitted in hospital after every 4 -5 months (rushed to hospital in emergency) with complaint of breathlessness. Doctors say that her heart strength is low (LEF at 20-25%) , she goes into heart failure and as a result water gets filled in her lungs resulting in breathlessness. For last 6 months she also suffered from angina pain.
A month back she suffered minor brain stroke (right brain) impacting her left hand (mainly) and leg. Doctors say most likely the root cause was low functioning of heart.
Due to high intake allopathic medicines and low water intake – as suggested by cardiologists – her kidney also got impact showing high levels of urea, creatnine and potassium. She has to be admitted to hospital for high potassium level 6.86. Last week the parameters were normal however two day back the levels of urea and creatnine were 62 and 1.1.
Medicines
We are taking following medicines
Acitrom 1 mg (1 time). Since INR was 1.47 it has now been recommended to take 2 mg after 1 days
Levipil 250 (2 times). Reduced from 500 mg earlier to 250 in last 2 days
Nitrocontin 2.5 ( 2 times)
Flavidon mr ( 2 times)
Carca 6.25 – ( 2 times)
Thyronorm 75 mg (1 time)
Febumac 40 (1 time)
Valent 40- ( 2 times)
Ecosprin 75 Av – (1 time)
Ecosprin 75 Av – (1 time)
Dexorange and nuhenz (1 time)
Nefrosave (2 times). Started 2 days back.
For dibeties
Trajenta 5 and Glynase 5 (breakfast) + Insulin if required
Questions
She feels drowsiness all the time. She cant sit at a place for more than 5- 10 minutes and feels like moving but after walking for one minutes or so she again sits. Our doctor suggested Lonazep as SOS medicine for restlessness. Is this normal with a patient undergoing such treatment. Is there anything that can be done about it so that drowsiness and the restlessness feeling can be avoided.
There has been a reasonable improvement in last one month post discharge but not what we expected. She can walk in home without help (earlier she needed support) but does not has confidence to go out of home. Her left hand moves and has gained strength but her fingers and wrist are not having sensation and not moving / not under her control. How much times does is take for complete recovery in such cases.
Does Levipil or any other neuro medicine impacts kidney function as urea and creatnine levels have increased again.
What is good range for PT/INR for her.
Are on the right track for treatment?
Thanks and regards
XXXXXX
Discharge summary
MRI
Latest blood test report
Old blood test report
Request for your advice on following.
Background
My mother is 67 years old. She is diabetic (type 2). In 2008 she was detected with multiple blockages in heart and had a undergone bypass surgery in 2008. She was on allopathic medicines since then.
For last 2 years she had to be admitted in hospital after every 4 -5 months (rushed to hospital in emergency) with complaint of breathlessness. Doctors say that her heart strength is low (LEF at 20-25%) , she goes into heart failure and as a result water gets filled in her lungs resulting in breathlessness. For last 6 months she also suffered from angina pain.
A month back she suffered minor brain stroke (right brain) impacting her left hand (mainly) and leg. Doctors say most likely the root cause was low functioning of heart.
Due to high intake allopathic medicines and low water intake – as suggested by cardiologists – her kidney also got impact showing high levels of urea, creatnine and potassium. She has to be admitted to hospital for high potassium level 6.86. Last week the parameters were normal however two day back the levels of urea and creatnine were 62 and 1.1.
Medicines
We are taking following medicines
Acitrom 1 mg (1 time). Since INR was 1.47 it has now been recommended to take 2 mg after 1 days
Levipil 250 (2 times). Reduced from 500 mg earlier to 250 in last 2 days
Nitrocontin 2.5 ( 2 times)
Flavidon mr ( 2 times)
Carca 6.25 – ( 2 times)
Thyronorm 75 mg (1 time)
Febumac 40 (1 time)
Valent 40- ( 2 times)
Ecosprin 75 Av – (1 time)
Ecosprin 75 Av – (1 time)
Dexorange and nuhenz (1 time)
Nefrosave (2 times). Started 2 days back.
For dibeties
Trajenta 5 and Glynase 5 (breakfast) + Insulin if required
Questions
She feels drowsiness all the time. She cant sit at a place for more than 5- 10 minutes and feels like moving but after walking for one minutes or so she again sits. Our doctor suggested Lonazep as SOS medicine for restlessness. Is this normal with a patient undergoing such treatment. Is there anything that can be done about it so that drowsiness and the restlessness feeling can be avoided.
There has been a reasonable improvement in last one month post discharge but not what we expected. She can walk in home without help (earlier she needed support) but does not has confidence to go out of home. Her left hand moves and has gained strength but her fingers and wrist are not having sensation and not moving / not under her control. How much times does is take for complete recovery in such cases.
Does Levipil or any other neuro medicine impacts kidney function as urea and creatnine levels have increased again.
What is good range for PT/INR for her.
Are on the right track for treatment?
Thanks and regards
XXXXXX
Discharge summary
MRI
Latest blood test report
Old blood test report
Brief Answer:
Recovery is along expected lines.
Detailed Answer:
Hi,
Thank you for posting your query.
I have noted your mother's details and her current status.
Unfortunately, she has multiple medical problems (diabetes, heart disease, brain stroke, thyroid problems and kidney problems).
All this would limit her functional status. However, we are happy to note her recovery so far, and it takes 3-6 months to regain the lost strength due to stroke.
All her medications are correct. However, I am not sure about levipil (levetiracetam). Did she have any fits (seizures), as this drug is used to prevent seizures.
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://XXXXXX
Recovery is along expected lines.
Detailed Answer:
Hi,
Thank you for posting your query.
I have noted your mother's details and her current status.
Unfortunately, she has multiple medical problems (diabetes, heart disease, brain stroke, thyroid problems and kidney problems).
All this would limit her functional status. However, we are happy to note her recovery so far, and it takes 3-6 months to regain the lost strength due to stroke.
All her medications are correct. However, I am not sure about levipil (levetiracetam). Did she have any fits (seizures), as this drug is used to prevent seizures.
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://XXXXXX
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doctor
Thanks for your reply. I am not sure she whether had fits, what I understand about fits / seizures in general sense she did not had and we were made aware of. She was admitted to hospital with situation where she was not able to speak and her left hand and leg became weak. After 1 or 2 minutes she regained it. This was again repeated next morning but she did not recovered as she did previously. What exactly fall under fit /seizure technically I am not sure.
Secondly, what drowsiness and restlessness is associated with any medicine or its a general situation for such patients.
Thirdly, Does Levipil or any other neuro medicine impacts kidney function as urea and creatnine levels have increased again.
Thanks
Thanks for your reply. I am not sure she whether had fits, what I understand about fits / seizures in general sense she did not had and we were made aware of. She was admitted to hospital with situation where she was not able to speak and her left hand and leg became weak. After 1 or 2 minutes she regained it. This was again repeated next morning but she did not recovered as she did previously. What exactly fall under fit /seizure technically I am not sure.
Secondly, what drowsiness and restlessness is associated with any medicine or its a general situation for such patients.
Thirdly, Does Levipil or any other neuro medicine impacts kidney function as urea and creatnine levels have increased again.
Thanks
Brief Answer:
Description does not sound like fits.
Detailed Answer:
Thank you for getting back.
The description does not sound like fits (mirgi in Hindi). So, levipil ay not be needed. However, please check with your doctor before stopping it.
Levipil may cause drowsiness in some people.
Levipil at this dose does not impact kidney function. However, in doses more than 500 mg twice daily, kidney function may get affected. Here, the kidney function impairment may be related to diabetes mellitus.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Description does not sound like fits.
Detailed Answer:
Thank you for getting back.
The description does not sound like fits (mirgi in Hindi). So, levipil ay not be needed. However, please check with your doctor before stopping it.
Levipil may cause drowsiness in some people.
Levipil at this dose does not impact kidney function. However, in doses more than 500 mg twice daily, kidney function may get affected. Here, the kidney function impairment may be related to diabetes mellitus.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Many thanks Doctor
She is also taking Acitrom 1 mg. Earlier it was 2mg but one day her INR results were 5.8 then doctor suggested to take Acitrom 1 mg. Recently on 1st October INR was 1.4 , the doctor then suggested to take Acitrom 1 for 2 days and then 2mg on third day, and repeat this cycle. After taking Acitrom 2 mg on 2nd Oct and 1mg on 3rd Oct, Today i.e. 4 Oct her INR is 2.9 (report enclosed). We repeat PT INR test every third day. There is a lot of fluctuation. Please let me know what is recommended range of INR in these cases. Is the dosage correct?
Please also let us know whether symptoms of drowsiness, restlessness and a bit of confusion that too everytime entire day are all related to Levipil or there could be some other reasons. This (situation) is troubling her the most.
Keeping in view all the facts would recommend us to take a second opinion on the entire treatment?
Thanks
She is also taking Acitrom 1 mg. Earlier it was 2mg but one day her INR results were 5.8 then doctor suggested to take Acitrom 1 mg. Recently on 1st October INR was 1.4 , the doctor then suggested to take Acitrom 1 for 2 days and then 2mg on third day, and repeat this cycle. After taking Acitrom 2 mg on 2nd Oct and 1mg on 3rd Oct, Today i.e. 4 Oct her INR is 2.9 (report enclosed). We repeat PT INR test every third day. There is a lot of fluctuation. Please let me know what is recommended range of INR in these cases. Is the dosage correct?
Please also let us know whether symptoms of drowsiness, restlessness and a bit of confusion that too everytime entire day are all related to Levipil or there could be some other reasons. This (situation) is troubling her the most.
Keeping in view all the facts would recommend us to take a second opinion on the entire treatment?
Thanks
Brief Answer:
Acitrom dose needs to be adjusted.
Detailed Answer:
Thank you for getting back.
Yes, Acitrom dose needs to be adjusted according to the PT/INR blood test report, and your doctors are doing the correct adjustments. The expected INR should be around 2.
Levipil could be one of the causes of drowsiness. Other factors could be due to stroke, general fatigue and tiredness due to multiple medical problems and low blood sodium.
There is no need to a second opinion at present.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Acitrom dose needs to be adjusted.
Detailed Answer:
Thank you for getting back.
Yes, Acitrom dose needs to be adjusted according to the PT/INR blood test report, and your doctors are doing the correct adjustments. The expected INR should be around 2.
Levipil could be one of the causes of drowsiness. Other factors could be due to stroke, general fatigue and tiredness due to multiple medical problems and low blood sodium.
There is no need to a second opinion at present.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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