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Coughing out phlegm, loss of appetite, vomiting, weakness. Suggest what should be given.

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My father is 70 yrs. old and is suffering from bulgum cough. He coughs out bulgum alot and feels like vomiting every time. He is not taking any food. It is just a bowl or two of soup he is taking in a day. He is feeling very weak. Kindly suggest what should we give him to make him feel better. He is feeling very week. Thanks for your help. If you can kindly help with following:
What diet he should follow? Why he is not feeling any hunger for food?
Why is he always feeling like vomiting?? he is coughing out yellowish color bulgum.
Is it fine to cough out bulgum like that?
Posted Sun, 22 Apr 2012 in Lung and Chest disorders
 
 
Answered by Dr. Gyanshankar Mishra 18 minutes later
Hi XXXXXXX

Thanks for posting the query on XXXXXXX

After going through the history, I would like to comment the following:

1. Currently your father has complaints of cough with expectoration along with vomiting. His food intake is also decreased.

2. Considering his old age, this seems to be a case of acute bronchitis with GERD (Gastro esophageal reflux disease).

3. You need to get him examined & investigated by a physician / Pulmonologist.

4. There are a few questions that need to be answered at this stage:
a. Since how long has your father been suffering from this cough?
b. Did your father used to smoke in the past? If so, for how long?
c. Does he have any associated breathlessness, fever or chest pain?
d. You mentioned that he is not taking his regular food. Is that due to decreased appetite or is he having trouble in swallowing?
e. Does he have any history of allergy?
f. At present does he have any associated cold or whistling sound during breathing?
g. Did he have any other chest complaints in the past?
h. Did he ever have his chest xray done in the past? If yes, then what was the finding?

Please do let me know the details so that I can advise accordingly.

Wish your father a speedy recovery.

Take care.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Above answer was peer-reviewed by
 
Follow-up: Coughing out phlegm, loss of appetite, vomiting, weakness. Suggest what should be given. 20 minutes later
Thanks for your reply doctor...
Pls. find the your queries answered below:
4. There are a few questions that need to be answered at this stage:
a. Since how long has your father been suffering from this cough?
Around last 1 and half week...

b. Did your father used to smoke in the past? If so, for how long?
He does not smoke...
c. Does he have any associated breathlessness, fever or chest pain?
he was having a high fever of 104 degree on monday....took crocin for that......but still he is having fever ( a bit lower now) and is taking flexon for that.

d. You mentioned that he is not taking his regular food. Is that due to decreased appetite or is he having trouble in swallowing?
He is not taking his normal food since last one week.....he said he is not feeling hungry....seems like lost appetite.... yesterday he took soup in the evening....and after some time juice...which he vomited after some time.

e. Does he have any history of allergy?
Not really.....can't remember any such incidence.....

f. At present does he have any associated cold or whistling sound during breathing?
Yes, when he breaths we can hear a sound....

g. Did he have any other chest complaints in the past?
Don't think so.....

h. Did he ever have his chest xray done in the past? If yes, then what was the finding?
No....

hope the answers will help you diagnose the problem...
 
 
Answered by Dr. Gyanshankar Mishra 23 minutes later
Hi,

Thanks for your prompt & specific reply.

From the information provided, I would like to comment the following:

1. Your father seems to be suffering from a respiratory infection at present which needs to be immediately managed. The respiratory infection may be acute bronchitis, bronchopneumonia or community acquired pneumonia mostly bacterial as per your description of symptoms.

2. You should immediately consult a physician / pulmonologist for the same who will accordingly examine and investigate your father.

3. As per your description, he has decrease food intake due to loss of appetite as also the vommiting associated with GERD (Gastroesophageal reflux disease) in such cases could be responsible for the symptoms.

4. You mentioned that he is feeling too weak and considering his decreased food intake, there is a high chance of the weakness being due to dehydration.

5. My assessment of the situation as per the complaints of the patient points towards the need of an urgent assessment by the physician and admit him in a hospital for management of the same considering his age and the potential complications associated with it.

6. He requires to be investigated and managed in the following way:
a. Investigations required: Chest xray PA view, complete blood count with Hb, Serum electrolytes, Kidney function and liver function tests, Sputum smear examination for AFB smear & gram stain and culture.
b. He requires measurement of his blood pressure, hydration status and oxygen saturation.
c. His clinical examination is mandatory.
d. His management will require a course of antibiotics, anta-acid, correction of dehydration by IV fluids or Oral re hydration solution along with supportive therapy.
e. His thyroid levels need to be rechecked.

7. If hospitalization is not possible currently, then you may start him on a course of antibiotic like Amoxycillin and Clavulinic acid, anta-acid like Omeprazole with Domperidone combination and Plenty of oral fluids (with ORS- Oral rehydrating solution-WHO based) in consultation with your physician. Meanwhile try to give him semi solid food (like khichdi).

8. After the management of this condition do consult your physician regarding vaccination of influenza and pneumococcus for him considering his age.

I hope this answers your query effectively. In case you have additional questions or doubts, you can forward them to me. Please accept my answer in case you do not have further queries.

Wishing your father a speedy and healthy recovery.

Regards.
Dr. Gyanshankar Mishra
MBBS MD DNB
Above answer was peer-reviewed by
 
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