98 years old having fever, rapid heartbeat and watery brown colored diarrhea. Treatment?

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Posted on Wed, 2 Jan 2013 in Digestion and Bowels
Question: My mother 98 years old has been having watery brown colored diarrhea it started as soft bowel movements three days ago this morning turned into diarrhea. Has fever of 101 and rapid heart beat of 100-110. Was in the hospital two days ago for treatment of dehydration and low potassium came home stable. She had taken a 3 day course of Cipro two weeks ago for a UTI. This morning we gave a stool sample for culture and also to check for C. Diff. Report will not come back till tomorrow afternoon should we start empirical treatment with Flagyl until the report comes back?
doctor
Answered by Dr. Charles S Narasi 12 hours later
Hello, XXXXXXX,
God bless your mother who is 98 years young.
C.Difficile infection is more common among
nursing home residents since the asymptomatic
carrier rate is high there and easy to contract the
infection.
At her age , there are are a number of causes for
sudden onset of diarrhea. From minor food poisoning,
diverticulitis, vascular causes (Ischemic colitis) , viral
etc. Since she was on Cipro two weeks ago, you are
absolutely correct in thinking about the possibility
of C.Difficile infection.
I agree with you starting her on Flagyl 250 mg. three
times a day (Lower dose since she is elderly) and make
sure her hydration is good. Yogurt (Plain) is good.
Pedialyte solution supplement is also good.
I wish her well.
Happy holidays.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Charles S Narasi 6 hours later
Dear Dr. Narasi
thank you very much for your reply the C Diff came back negative although she is continuing to have loose stools we are doing as much as possible to orally hydrate her with Pedialyte is it OK to try Immodium?
thanks
XXXXXXX
doctor
Answered by Dr. Charles S Narasi 53 minutes later
Hello, XXXXXXX,
Hope they tested the stool for both Toxin A and Toxin B.
Pedialyte is fine for hydration. Imodium will stop the diarrhea.
Sometimes, just one capsule may bind her up at that age.
Have to be careful. Peptobismol liquid one teaspoon three times
a day may be better for her. But, I wan't to caution you that her
stool might turn dark or black from bismuth. Don't worry.
Wish her well.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Charles S Narasi 5 hours later
Dr Narasi
thanks again for your reply. They tested the stool using the nucleic acid amplification method which is the latest FDA approved test and should cover both Toxin A and B. Her other stool cultures will come back tomorrow but she continues to have loose stools three to four times a day her fever is gone and her heart rate is around 80 now. We did give her a dose of Imodium but it did not help and we are trying our best to keep her hydrated. Question is should we continue with the Flagyl which we stopped after the negative C Diff result is it possible that we got a false negative and is there anything else we can try? Today its been 36 hrs since it started could this be viral?
Regards
doctor
Answered by Dr. Charles S Narasi 10 hours later
Hello, XXXXXXX,
It is possible to have a false negative test.
Until you get more results from the stool
culture , I don't see any problem in continuing
Flagyl.
As I had mentioned before , there are other
causes of diarrhea in an elderly including viral.
If it is viral, most often it is self limiting and
should get better.
I wish her well.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Charles S Narasi

Gastroenterologist

Practicing since :1962

Answered : 693 Questions

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