I'm new to all this. I look after an elderly man who was diagnosed with partial epilepsy in August. He was put on Epilim but it has made his blood sodium levels go right down to 120. He is weak and lethargic and when he gets dehydrated he has a fit. The neurologist saw him 3 days ago and is changing him over to Keppra but it will take about 2 months and right now he has had to intoduce the Keppra am on top of the Epilim. He is so drugged he is sleeping all the time and is unsteady on his legs whcih are already a bit feeble. Do things improve the longer you are on the tablet because right now he is so drugged and miserable he can't do a thing.
Recently diagnosed and need help and advice
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skillefer
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Hi bradda! Welcome to CWE. It's not unusual for people to get really lethargic due to meds. In fact, it's probably a combo of the Keppra and Epilim that's making him so tired. In the meantime, I'd suggest making sure that he drinks a sport drink like Gatorade...something to help keep his electrolytes in balance. Also, report the severe lethargy to his doctor. If nothing else, he'll tell you to keep monitoring it. Eventually, as the epilim is cut back the symptoms will hopefully diminish.
Hi Skillefer! thanks for your reply. It's so good to be in touch with others who share the same problem. I have felt so lost since his diagnosis as we got no help or advice fro the doctor or hospital other than look it up on the internet. I was not even told that it may take some while for him to wake up after he had stopped fitting - all v ery scary for a first time carer. He of course, doesn't remember a thing as his fits happen in his sleep so he doesn't et any warning signs or funny feelings before hand. It's going to take months to change over drugs and he will be on a much higher dose of Keppra than now before he can even start reducing the Epilim so I guess that he will have to accept his drugged and zombie state for quite some time. Will sports drinks push his potassium up because that is normal? It is only his sodium level which is very low.
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Dear bradda,
Welcome !:hello: . About the low sodium , while it has been reported , it is a pretty rare side effect of epilim. it is important for you to know that keppra can ALSO cause low sodium levels and you should titrate the drug accordingly with your doctor.
A persistent sodium level of 120 is not acceptable (normal - 135-145meq/L) and i feel perhaps a stay in the hospital for a day or two to correct this may be warranted. They will need to load him up with i'v saline slowly. if you don't want to go to the hospital , then i suggest , as skillefer said , a sport drink , or if not , ORS ( the salts packet to be dissolved in a litre of water that your dc gives you when you have diarrhoea.)
Again , i reiterate that you need to get this sodium thing sorted out asap as low sodium levels can push a patient with epilepsy into status epilepticus. And no , the body will not increase his potassium as well , so you don't have to worry about that. This is assuming that his kidneys are fine. For a few days, try to avoid gving him tap water, and quench his thirst with gatorade or the ORS solution , and restrict his pure water intake to 3-4 glasses a day max. You can also try mixing lemonade ( sugar , salt ,water, lemons) provided he's not diabetic. Try these measures out for a few days and get someone to repeat the electrolyte counts. See if they've gone up. Any idea if he is hypertensive ? if he is , then you may need a consult with your physician to determine if his BP or sodium levels should take precedence.
If you want more information , you can read up on hyponatremia on emedicine at the link given below:
http://www.emedicine.com/emerg/topic275.htm
It's written for doctors , but the language is pretty comprehensible. If you have any further questoins , please don't hesitate to ask
Welcome !:hello: . About the low sodium , while it has been reported , it is a pretty rare side effect of epilim. it is important for you to know that keppra can ALSO cause low sodium levels and you should titrate the drug accordingly with your doctor.
A persistent sodium level of 120 is not acceptable (normal - 135-145meq/L) and i feel perhaps a stay in the hospital for a day or two to correct this may be warranted. They will need to load him up with i'v saline slowly. if you don't want to go to the hospital , then i suggest , as skillefer said , a sport drink , or if not , ORS ( the salts packet to be dissolved in a litre of water that your dc gives you when you have diarrhoea.)
Again , i reiterate that you need to get this sodium thing sorted out asap as low sodium levels can push a patient with epilepsy into status epilepticus. And no , the body will not increase his potassium as well , so you don't have to worry about that. This is assuming that his kidneys are fine. For a few days, try to avoid gving him tap water, and quench his thirst with gatorade or the ORS solution , and restrict his pure water intake to 3-4 glasses a day max. You can also try mixing lemonade ( sugar , salt ,water, lemons) provided he's not diabetic. Try these measures out for a few days and get someone to repeat the electrolyte counts. See if they've gone up. Any idea if he is hypertensive ? if he is , then you may need a consult with your physician to determine if his BP or sodium levels should take precedence.
If you want more information , you can read up on hyponatremia on emedicine at the link given below:
http://www.emedicine.com/emerg/topic275.htm
It's written for doctors , but the language is pretty comprehensible. If you have any further questoins , please don't hesitate to ask
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Hi bradda, welcome to the forum. :hello:
He is lucky to have someone like you watching out for him (who cares enough to seek out help/answers).
I cut out the superfluous parts. What remains is exactly how Epilim affected my wife - it turned her into a zombie/vegetable.
Everyone tolerates drugs differently though. It's quite possible that as soon as he titrates off the Epilim, he will regain his vigor.
I don't see many (any?) complaints of Keppra making people drowsy/lethargic like I do with Epilim/Depakote/sodium valproate.
Since you are new to the world of E, have a look here: epilepsy 101 discussions
He is lucky to have someone like you watching out for him (who cares enough to seek out help/answers).
I cut out the superfluous parts. What remains is exactly how Epilim affected my wife - it turned her into a zombie/vegetable.
Everyone tolerates drugs differently though. It's quite possible that as soon as he titrates off the Epilim, he will regain his vigor.
I don't see many (any?) complaints of Keppra making people drowsy/lethargic like I do with Epilim/Depakote/sodium valproate.
Since you are new to the world of E, have a look here: epilepsy 101 discussions
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If his kidneys are not fine, Keppra is a dangerous (IMO) drug for him to be taking. The body eliminates Keppra via the kidneys (not the liver).
HI fOLKS!
As I said before I am thrilled to have contact with people who care can advise. His kidneys are not that bad but he is in his late 80's so bound to be not as good as ours. The doctors are so laid back and uninformative. He has heart disease (bypass surgery 10 years ago and a pacemaker) but his BP is ok and we keep a close eye on it as it was going low so he had to come off a bp tablet. At he moment I am giving him salted crisps and salt on his porridge as instructed by the GP. However I will get some sports drinks if it won't load him with potassium. He had to stop eating bananas as his potassium was too high. Had a blood test today and will get the results on Wednesday. Can this low sodium problem contribute to his tiredness? He has to be careful walking as he had polio when he was six so has a withered leg. He sounds bad doesn't he, but he is a dear who never moans but justs gets on with it and keeps proving the doctors wrong! He was told at six that he would never walk again but they got that wrong too! This forum has been a godsend to me as the y just shoved him on epilim in hospital on August 14 and send him home with no information about epilepsy or the drug and no advice. We are living in a third world country in the Uk as regards health care. He didn't get to see the neurologist until Nov.14 but we need to keep him out of hospital if at all possible. They are not very caring when you get old. They give tablets out at their convenience not when you should have them. His epilim was given at about 10am and then 5pm. A long gap thenuntil 10am the next morning so drug levels in the blood drop. Crazy or what?
As I said before I am thrilled to have contact with people who care can advise. His kidneys are not that bad but he is in his late 80's so bound to be not as good as ours. The doctors are so laid back and uninformative. He has heart disease (bypass surgery 10 years ago and a pacemaker) but his BP is ok and we keep a close eye on it as it was going low so he had to come off a bp tablet. At he moment I am giving him salted crisps and salt on his porridge as instructed by the GP. However I will get some sports drinks if it won't load him with potassium. He had to stop eating bananas as his potassium was too high. Had a blood test today and will get the results on Wednesday. Can this low sodium problem contribute to his tiredness? He has to be careful walking as he had polio when he was six so has a withered leg. He sounds bad doesn't he, but he is a dear who never moans but justs gets on with it and keeps proving the doctors wrong! He was told at six that he would never walk again but they got that wrong too! This forum has been a godsend to me as the y just shoved him on epilim in hospital on August 14 and send him home with no information about epilepsy or the drug and no advice. We are living in a third world country in the Uk as regards health care. He didn't get to see the neurologist until Nov.14 but we need to keep him out of hospital if at all possible. They are not very caring when you get old. They give tablets out at their convenience not when you should have them. His epilim was given at about 10am and then 5pm. A long gap thenuntil 10am the next morning so drug levels in the blood drop. Crazy or what?
Thanks Bernard. It all sounds worrying. Is there anything you can do on a permanent basis to keep sodium levels safely up? The trouble is he gets dehydrated if he doesn't drink enough and that seems to be when he has a fit. They are definitely linked to dehydration.
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In the middle east, they put a lot of salt and lemon juice in their foods to keep up their sodium and potassium levels. Maybe some lemonade with salt (try using Stevia instead of sugar) would help? I don't know.
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Dear Bradda,
In reply to your q , yes , the low sodium levels can be blamed for his feeling tired and "zonked"(a word my dad uses to describe extreme tiredness) all the time , but epilim can also do that. I have had similar problems with epilim.I take about 1500mgs a day and feel totally knocked out when i sleep and it is near impossible to wake me up.I also feel drowsy durinng the day, so maybe the truth about his problem is partly epilim and partly the sodium levels. he may also experience mental status changes , for instance he may be confused or have sudden bursts of emotion. As for what you can do to maintain the levels , i suggest you integrate a salty snack into his diet. Not too much because of his history of heart disease. he can drink slightly less than what you (any normal person) drink , only try not to give him too much tap water. you can mix a variety of fluids into his diet . salt and sugar lemonade , as i suggested is OK provided he is not diabetic. Again , here a delicate balance must be maintained. His heart will not tolerate an excess of fluids in his system. It is important that he not be dehydrated but at the same time not be loaded up on liquids.It's going to take careful monitoring on your part. I suggest a kidney screen before embarking on an electrolyte juggling odyssee. I wish you the best of luck and hope that he gets well soon.
In reply to your q , yes , the low sodium levels can be blamed for his feeling tired and "zonked"(a word my dad uses to describe extreme tiredness) all the time , but epilim can also do that. I have had similar problems with epilim.I take about 1500mgs a day and feel totally knocked out when i sleep and it is near impossible to wake me up.I also feel drowsy durinng the day, so maybe the truth about his problem is partly epilim and partly the sodium levels. he may also experience mental status changes , for instance he may be confused or have sudden bursts of emotion. As for what you can do to maintain the levels , i suggest you integrate a salty snack into his diet. Not too much because of his history of heart disease. he can drink slightly less than what you (any normal person) drink , only try not to give him too much tap water. you can mix a variety of fluids into his diet . salt and sugar lemonade , as i suggested is OK provided he is not diabetic. Again , here a delicate balance must be maintained. His heart will not tolerate an excess of fluids in his system. It is important that he not be dehydrated but at the same time not be loaded up on liquids.It's going to take careful monitoring on your part. I suggest a kidney screen before embarking on an electrolyte juggling odyssee. I wish you the best of luck and hope that he gets well soon.
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