Question: Hello
My father aged 71 yrs has had a cerebellar infarction in 2011 followed by a CABG and PPI in 2012. He also has COPD. During his stay in the hospital in 2012 for PPI, he developed CCU psychosis and went into a state of delirium. After that incident, everytime he has been hospitalized, he has been experiencing delirum, agitation and confusion. He was diagnosed to be having Dementia and was put on Donep 5mg. After a short course of Donep, we consulted another Neurologist, who prescribed him Donamem 5, Quitipin 25 along with Benfomet Plus.

He recently had a head injury which resulted in a thin subdural hemorrhage but the attending Neuro Surgeon said that his injury is hardly noticeable and hence poses no threat to his life. My father also has a condition where his Sodium levels tend to drop frequently and is currently hospitalized following hyponatremia along with a chest infection.

This time also, even though he is fully conscious, he is confused and saying irrelevant things. He has problems identifying where he is staying now but has no problem recognizing people. However, sometimes he thinks that a nurse or an attendant to be someone else that he knows. So he is in a state of delirium again.

After his stroke, he displayed similar signs but was fully cured afterwards and resumed normal day to day routines without any difficulties. But in February and March 2014, his sodium levels dropped to 121 and 114 respectively, for which he needed hospitalization and during those stays, his delirium aggravated and has been more or less in a confused state since then.

My question is, why did this suddenly happen after staying normal for these years? Is this curable and does this pose any life threat to him. Kindly advise as we are very worried

Hello Dr XXXXXXX

Thank you very much for your assessment and reply.

Another thing worth mentioning here, that within a few hours after my father sustained the head injury recently, he went into a state of extreme agitation and confusion. He was going to the kitchen instead of the bathroom for urinating and was totally disoriented.

Also his state of confusion and disorientation aggravates at around the evening and peaks at night. During the day time, he is more or less normal.

With the recent set of medications he is having, would it be safe to continue Donamem 5 along with Qutipin 25? or should he make any alterations to these medications?

Thanks again

Thanks doctor

I also notice that he shivers (arms, legs and body) moderately when he is sleeping and his arms shiver when he is awake. What could be the reason for that and would you suggest anything to take care of the shivering.

Also my father has been hospitalized thrice this year following hyponatremia. He was put on Natrise (tolvaptam) 15mg for a few days and during that time his Sodium Levels increased to 138. However, after stopping Natrise, his sodium levels dropped again, despite being on a fluid restriction of 1.5 ltrs a day and oral administration of 5-7.5 Mg of table salt.

Please advise on how we can manage his Hyponatremia so that the Sodium levels remain normal? Since he is hypertensive, we are reluctant to give him too much table salt. Is there a medicine or a tonic that he can take for maintaining normal sodium levels?

Many thanks!