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What Causes Aggrevation Of COPD And CHF In An Elderly Patient?
Question: If an elderly patient has COPD, CCF (with pacemaker), an ongoing pleural effusion, dyspnea, dysphagia, dysarrthria, T2 diabetes, major depression, hypoxia, severe malnutrition, myeloproliferative disorder (without acute transformation), hypernatremia, has been hypotensive and afebrile for weeks, has had a high C Reactive Protein level and high WCC for weeks, major depression, gout, mouth ulcers on tongue, nonambulant for weeks, small pelvic fracture, cyanosis, two TIAs a few years ago, complains of pain, and now has delirium, pneumonia and suspected sepsis could there be any significance in the fact that the 0.5 mg of haloperidol has no had effect even after several hours? Could it indicate that one of the underlying conditions has become worse or is underestimated?
Brief Answer:
Detail Follows.
Detailed Answer:
Dear Friend.
Welcome to HCM. I am Dr Anshul Varshney. I understand your concern.
He has so many co morbid conditions.
In fact with your details it seems his COPD and CHF are further aggravated due to sepsis.
In cases of delerium that might be because of sepsis or pneumonia we avoid any sedatives.
However haloperidol is a preferred one in such state.
The dose given to him is very low and more dosage should be used only if severe sedation is required. As if we increase sedation it becomes difficult for us to access the consciousness level.
Haloperidol at this dose is going to effect him only transiently. Infact its effect can't be co related with any aggravation of condition or severity of disease.
I hope I am able to answer your query.
If you have any further query please feel free to ask me.
I wish him a speedy recovery.
Stay Healthy.
Detail Follows.
Detailed Answer:
Dear Friend.
Welcome to HCM. I am Dr Anshul Varshney. I understand your concern.
He has so many co morbid conditions.
In fact with your details it seems his COPD and CHF are further aggravated due to sepsis.
In cases of delerium that might be because of sepsis or pneumonia we avoid any sedatives.
However haloperidol is a preferred one in such state.
The dose given to him is very low and more dosage should be used only if severe sedation is required. As if we increase sedation it becomes difficult for us to access the consciousness level.
Haloperidol at this dose is going to effect him only transiently. Infact its effect can't be co related with any aggravation of condition or severity of disease.
I hope I am able to answer your query.
If you have any further query please feel free to ask me.
I wish him a speedy recovery.
Stay Healthy.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr Varshney for the very helpful information. I understand that there are risks in highly sedating the patient. However, since the 0.5 mg of haloperidol was inefficacious could there be any danger in these circumstances if the patient continues to experience agitated delirium for several hours.
Brief Answer:
Detail Follows.
Detailed Answer:
Dear Friend.
Important here is to find out the reason for his agitated behavior and delerium. Your doctors by now must have found.
Let me tell you a very interesting fact. I person don't sedate my patient in such condition until and unless he becomes threat to himself by injuring himself. This I do because an agigated patient can be assessed for his neurological examination. We can't assess a patient who is sedated. Moreover chances of recovery are more in patients who are not sedated as a sedated patient can aspirate food or water into his lungs that can aggravate pneumonia.
A conscious but agigared patient is much better then unconscious , non responsive patient!!
Hope you understand what I mean.
If you have any further query please ask me.
Stay Healthy
Detail Follows.
Detailed Answer:
Dear Friend.
Important here is to find out the reason for his agitated behavior and delerium. Your doctors by now must have found.
Let me tell you a very interesting fact. I person don't sedate my patient in such condition until and unless he becomes threat to himself by injuring himself. This I do because an agigated patient can be assessed for his neurological examination. We can't assess a patient who is sedated. Moreover chances of recovery are more in patients who are not sedated as a sedated patient can aspirate food or water into his lungs that can aggravate pneumonia.
A conscious but agigared patient is much better then unconscious , non responsive patient!!
Hope you understand what I mean.
If you have any further query please ask me.
Stay Healthy
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Varshney, Thank you for your valuable medical advice. I appreciate that the situation is complex. However, the patient is also in pain. I understand that analgesia may have unhelpful side effects as well, e.g., sedation. Is there anything that could be done to bring a degree of pain relief? Because of the complexity of the comordities and patient's age, would it be worthwhile consulting a palliative care team even if the person isn't necessarily terminal?
Brief Answer:
Detail Follows.
Detailed Answer:
Dear Friend.
Palliative care is advisable when the doctors have given the hope and the decision is taken just to make the life comfortable.
For pain relief , consulting a specialist dealing with pain relief is worth.
In his condition what is the reason of his pain?
Palliative care is mostly given to patients who have cancer which is not further treatable.
Good luck.
Detail Follows.
Detailed Answer:
Dear Friend.
Palliative care is advisable when the doctors have given the hope and the decision is taken just to make the life comfortable.
For pain relief , consulting a specialist dealing with pain relief is worth.
In his condition what is the reason of his pain?
Palliative care is mostly given to patients who have cancer which is not further treatable.
Good luck.
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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