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Suggest Treatment For Loss Of Memory And Sever Itching On The Whole Body
Question: Cause: Loss of memory and awareness, Patient is currently in ICU.
History:
My Dad is 62 years old. He is a retired government employee. From past 2 years, he is at home and has been leading sedentary lifestyle. He is diabetic since 26 years and He has blood pressure since 10 years. He is using insulin injections since 15 years. We started seeing kidney anomalies since 5-6 years. The creatinine, urea levels started rising above normal range since 1 year. We started the dialysis since October 13, 2014 because his legs were swollen, was vomiting and he had severe itching almost all over the body. At first, dialysis was 3 times a week and now it is 2 times a week. The AV fistula is done on his left hand. There was no significant decrease in urea level even after the dialysis process. His urea level had always been around 65-80.
After the dialysis was started, for 1.5 months, though he lost 15 kgs, he was fine. He was on high protein diet and occasionally used to vomit. He often mentioned that he does NOT have much strength in his legs, it is difficult for him to get up from chair or walk for long distance. He did not mention about imbalance but only mentioned of lack of strength.
Recent symptoms:(past 15 - 20) days
-> he gets headache occasionally, usually when he wakes up.
-> He has got herpes on his left leg since 7th December and it has spread a little to his left buttock and to the right ankle. It is bit doubtful that it is on his buttock because it is difficult to differentiate between itching marks and blisters.
-> Since 20 days month there were few times, when he wakes from the nap/sleep, he had no idea, where he is and he used to forget where is the kitchen, bathroom. He was able to recall once we explain. This memory loss condition lasted only for few minutes and it was intermittent. He has fallen down couple of times while getting out of the bed or the chair and this may have happened because of imbalance rather than the lack of strength in his legs.
-> On 13th December the memory loss got way to severe he used to forget once every 5 minutes. This time, the condition lasted for more than 8 hours and his sugar levels were high so we took him to the doctor.
-> Sugar levels 400 on 11th December and 554 on 13th December. Blood pressure 160, Urea 110, Creatinine 6.5.
-> There has been no fever recently
-> There has been no frequent vomiting recently.
-> He has never wet the bed and always knew whenever he wants to urinate and went to the bath room.
Initial treatment:
The doctor said the memory loss condition might have happened because of high sugar level (500). We got him admitted and his sugar levels were brought down but there was no improvement on the memory part and it was getting worse. On 14th December, the doctor recommended a different hospital and adviced to consult a neuro surgeon as his condition was deteriorating. On 14th December evening, my dad was admitted to ICU with ventilator as he was not opening his eyes and was not responding to our words. He was reacting to the pain, move his hands but he was not self aware.
The treatment that has been done so far is mentioned in the attached reports. The attached various reports are clinical summary, all tests results, X-ray result, MRI film and report. Please refer all the documents.
CLINICAL_SUMMARY - https://drive.google.com/file/d/0B6t2wBlPTTSQcFhLdE5fM3V2dUU/view?usp=sharing
Note : The first file in google drive is consolidated one, please ignore that file and you may download rest of the files and go through it.
MRI_CONTRAST - https://drive.google.com/file/d/0B6t2wBlPTTSQTl9HVWhMRjNjUU0/view?usp=sharing
MRI_PLAIN - https://drive.google.com/file/d/0B6t2wBlPTTSQeW9vR01EWVVWRzQ/view?usp=sharing
My questions:
1) What treatment should be provided now since his immunity is dropped and he is vulnerable ?
2) How many more days it would take for him to recover and move out of the ICU ?
3) How will be his life after he gets discharged ? Will he be bedridden or can he lead a normal life?
please let me know suggestions as soon as possible
History:
My Dad is 62 years old. He is a retired government employee. From past 2 years, he is at home and has been leading sedentary lifestyle. He is diabetic since 26 years and He has blood pressure since 10 years. He is using insulin injections since 15 years. We started seeing kidney anomalies since 5-6 years. The creatinine, urea levels started rising above normal range since 1 year. We started the dialysis since October 13, 2014 because his legs were swollen, was vomiting and he had severe itching almost all over the body. At first, dialysis was 3 times a week and now it is 2 times a week. The AV fistula is done on his left hand. There was no significant decrease in urea level even after the dialysis process. His urea level had always been around 65-80.
After the dialysis was started, for 1.5 months, though he lost 15 kgs, he was fine. He was on high protein diet and occasionally used to vomit. He often mentioned that he does NOT have much strength in his legs, it is difficult for him to get up from chair or walk for long distance. He did not mention about imbalance but only mentioned of lack of strength.
Recent symptoms:(past 15 - 20) days
-> he gets headache occasionally, usually when he wakes up.
-> He has got herpes on his left leg since 7th December and it has spread a little to his left buttock and to the right ankle. It is bit doubtful that it is on his buttock because it is difficult to differentiate between itching marks and blisters.
-> Since 20 days month there were few times, when he wakes from the nap/sleep, he had no idea, where he is and he used to forget where is the kitchen, bathroom. He was able to recall once we explain. This memory loss condition lasted only for few minutes and it was intermittent. He has fallen down couple of times while getting out of the bed or the chair and this may have happened because of imbalance rather than the lack of strength in his legs.
-> On 13th December the memory loss got way to severe he used to forget once every 5 minutes. This time, the condition lasted for more than 8 hours and his sugar levels were high so we took him to the doctor.
-> Sugar levels 400 on 11th December and 554 on 13th December. Blood pressure 160, Urea 110, Creatinine 6.5.
-> There has been no fever recently
-> There has been no frequent vomiting recently.
-> He has never wet the bed and always knew whenever he wants to urinate and went to the bath room.
Initial treatment:
The doctor said the memory loss condition might have happened because of high sugar level (500). We got him admitted and his sugar levels were brought down but there was no improvement on the memory part and it was getting worse. On 14th December, the doctor recommended a different hospital and adviced to consult a neuro surgeon as his condition was deteriorating. On 14th December evening, my dad was admitted to ICU with ventilator as he was not opening his eyes and was not responding to our words. He was reacting to the pain, move his hands but he was not self aware.
The treatment that has been done so far is mentioned in the attached reports. The attached various reports are clinical summary, all tests results, X-ray result, MRI film and report. Please refer all the documents.
CLINICAL_SUMMARY - https://drive.google.com/file/d/0B6t2wBlPTTSQcFhLdE5fM3V2dUU/view?usp=sharing
Note : The first file in google drive is consolidated one, please ignore that file and you may download rest of the files and go through it.
MRI_CONTRAST - https://drive.google.com/file/d/0B6t2wBlPTTSQTl9HVWhMRjNjUU0/view?usp=sharing
MRI_PLAIN - https://drive.google.com/file/d/0B6t2wBlPTTSQeW9vR01EWVVWRzQ/view?usp=sharing
My questions:
1) What treatment should be provided now since his immunity is dropped and he is vulnerable ?
2) How many more days it would take for him to recover and move out of the ICU ?
3) How will be his life after he gets discharged ? Will he be bedridden or can he lead a normal life?
please let me know suggestions as soon as possible
Brief Answer:
It's most likely due to Infection-- SEPSIS.
Detailed Answer:
HI
Greetings from Dr.Divakara.P
Thanks for posting your query.
Yes his immunity is low and the cause for that is his Diabetes and Kidney failure. There are many causes for Memory problems from Simple Vitamin Deficiency to Stroke .
But in his present condition he is having Pneumonia and very low oxygen levels in his blood . This itself can explain his memory problems-- it is called as Septic Encephalopathy/ Hypoxic Ischemic Encephalopathy. This could have been the initial cause or it could have happened once he was hospitalized and the initial cause could have been something else.
Now the evaluation begins from his present condition that is first his Pneumonia and low oxygen levels has to be corrected and then observe what happens to his neurological condition. Once he is out of ventilator and if the memory problem persists then further evaluation of the cause has to be done .
His urine report is showing that he is losing lot of proteins in urine and because of that his blood protein levels ( Albumin ) is low . I would recommend a Human Albumin transfusion during dialysis.
Apart from antibiotic I would recommend Injection Hydrocortisone ( if it's not been given ) , also start him on TPN.
I would also like to see his recent Arterial Blood Gas Analysis ( ABG )report and let me know his Heart rate , blood pressure , Urine output .
It may take 1-2 weeks more to recover and move out of ICU.
He may not be bedridden after discharge but he shall be very weak and dependent on other for activities of daily life .
My recommendation is to consider a Kidney transplant once he is stable .
Hope this information was useful to you .
Any clarifications feel free to ask .
It's most likely due to Infection-- SEPSIS.
Detailed Answer:
HI
Greetings from Dr.Divakara.P
Thanks for posting your query.
Yes his immunity is low and the cause for that is his Diabetes and Kidney failure. There are many causes for Memory problems from Simple Vitamin Deficiency to Stroke .
But in his present condition he is having Pneumonia and very low oxygen levels in his blood . This itself can explain his memory problems-- it is called as Septic Encephalopathy/ Hypoxic Ischemic Encephalopathy. This could have been the initial cause or it could have happened once he was hospitalized and the initial cause could have been something else.
Now the evaluation begins from his present condition that is first his Pneumonia and low oxygen levels has to be corrected and then observe what happens to his neurological condition. Once he is out of ventilator and if the memory problem persists then further evaluation of the cause has to be done .
His urine report is showing that he is losing lot of proteins in urine and because of that his blood protein levels ( Albumin ) is low . I would recommend a Human Albumin transfusion during dialysis.
Apart from antibiotic I would recommend Injection Hydrocortisone ( if it's not been given ) , also start him on TPN.
I would also like to see his recent Arterial Blood Gas Analysis ( ABG )report and let me know his Heart rate , blood pressure , Urine output .
It may take 1-2 weeks more to recover and move out of ICU.
He may not be bedridden after discharge but he shall be very weak and dependent on other for activities of daily life .
My recommendation is to consider a Kidney transplant once he is stable .
Hope this information was useful to you .
Any clarifications feel free to ask .
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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