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89 Years Old Having End-stage Renal Failure, Hypertension, Type 2 Diabetes, COPD. What Cure Should Be Taken?
Question: My Mother is 89 yrs old and in poor health. She has end-stage renal failure, hypertension, type 2 diabetes, COPD. She is currently in the hospital with Pneumonia and a UTI. Upon admission, her WBC was 26.9, up from 17.8 the day prior. She is on a Sepapine IV drip, and in about 26 hours, her WBC has come down to 20.8. She is still very weak and lethargic, is not eating (minut bits of food for 9 days) and drinks sporadically. Should she still be acting like this considering that her WBC has started coming down? Understandably, she has a very serious infection, but when should we start to see a change (is there a window of time typically)? I am concerned because she has barely any moments of alertness now for about 20 hours. Her vitals have been very good and her sugar levels are holding steady at around 96.
Hi XXXXXX,
Welcome to healthcare magic!
Your mother has got pneumonia and drowsy state with very high WBC counts and she has got significant comorbidities in form of End-stage renal failure, Hypertension, Type 2 diabetes and the COPD.
This syndrome is called Sepsis.
It is a state of serious systemic infection.
Elderly persons have a high variation in the response to treatment depending on back-ground health, the micro-organism which is causing the infection and the status of disease when the treatment was started.
WBC count is a lay man indicator of infection and does not hold promise with telling the ultimate outcome.
It is in-fact one of the almost forty-fifty parameters your clinician observes and uses in his mind to get an idea of patient's condition and response to treatment.
The antibiotic you wanted to tell is probably Cefepime, which is fourth generation cephalosporin and quite effective drug for such infections.
I would like to send the Blood and urine cultures and sensitivity tests as soon as possible if they have not sent.
And I would also like to add Injectable Clindamycin 300mg thrice a day in view of seriousness of the infection to cover the gram positive and un-aerobic micro-organisms which are also a fairly common cause/additional finding in such cases.
But I must admit that your mother has to be fairly lucky to come out of the claws of this evil in view of her immunocompromised state due to the comorbidities.
These patients tend to have a waxing and waning clinical course and bear approximately 25-40% risk of death despite the best management including the ICU Treatment.
I hope this advise would be helpful for you.
Still if you have any queries or doubts, please write me back,
I would be happy to solve them.
Wish you a great health!
Welcome to healthcare magic!
Your mother has got pneumonia and drowsy state with very high WBC counts and she has got significant comorbidities in form of End-stage renal failure, Hypertension, Type 2 diabetes and the COPD.
This syndrome is called Sepsis.
It is a state of serious systemic infection.
Elderly persons have a high variation in the response to treatment depending on back-ground health, the micro-organism which is causing the infection and the status of disease when the treatment was started.
WBC count is a lay man indicator of infection and does not hold promise with telling the ultimate outcome.
It is in-fact one of the almost forty-fifty parameters your clinician observes and uses in his mind to get an idea of patient's condition and response to treatment.
The antibiotic you wanted to tell is probably Cefepime, which is fourth generation cephalosporin and quite effective drug for such infections.
I would like to send the Blood and urine cultures and sensitivity tests as soon as possible if they have not sent.
And I would also like to add Injectable Clindamycin 300mg thrice a day in view of seriousness of the infection to cover the gram positive and un-aerobic micro-organisms which are also a fairly common cause/additional finding in such cases.
But I must admit that your mother has to be fairly lucky to come out of the claws of this evil in view of her immunocompromised state due to the comorbidities.
These patients tend to have a waxing and waning clinical course and bear approximately 25-40% risk of death despite the best management including the ICU Treatment.
I hope this advise would be helpful for you.
Still if you have any queries or doubts, please write me back,
I would be happy to solve them.
Wish you a great health!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your response. The illnesses mentioned were prior to the infection and not the result there of. My feelings are that unfortunately and sadly, she is approaching death. As I stated, she has not really eaten much of anything since last week. Drinks a few sips here and there. Is basically sleeping continuously. She missed dialysis last Tues because of not feeling well and had to go Wed & Thur, as a result she gained 5 pounds between the two days that tells me they are not really working. She is not really voiding or hsving bm's either. It just all seems to be pointing at end of life. Am i correct to say this? I must admit, I've not had the word sepsis mentioned to me however regarding any of this.
Hi XXXXXX,
I am so sorry to know that she is further deteriorating.
But in the hospital they can easily feed her with a Ryles tube and bowels can be moved with enemas.
At least just to keep the patient comfortable even if the ultimate disease may not be curable even then patient pain distress hunger and daily routine should be the goal.
Please ask your physician to give tube feeds just for the sake of comfort to patient.
Hemodialysis can help improve her awakening to some extent and is a worthwhile try.
Where response to treatment is not salutary then the patients comfort should be taken care of, this is called the palliative and supportive care in modern medicine.
I hope you would be strong enough to carry on in this difficult hour of life!
I am so sorry to know that she is further deteriorating.
But in the hospital they can easily feed her with a Ryles tube and bowels can be moved with enemas.
At least just to keep the patient comfortable even if the ultimate disease may not be curable even then patient pain distress hunger and daily routine should be the goal.
Please ask your physician to give tube feeds just for the sake of comfort to patient.
Hemodialysis can help improve her awakening to some extent and is a worthwhile try.
Where response to treatment is not salutary then the patients comfort should be taken care of, this is called the palliative and supportive care in modern medicine.
I hope you would be strong enough to carry on in this difficult hour of life!
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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