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Does TIA cause acute urine retention with delirium?

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Cardiologist
Practicing since : 2004
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This is a complicated story. My 87 year old mother had an aortic valve replaced via TAVI on 2nd of July. The op went well and she was sent home after 3 days. Since then she has got progressively more tired and weak. On Monday she also started shakIng and needed to urinate more frequently than normal. On Wednesday she was so tired she couldn't be bothered to talk. Her blood pressure has been fluctuating anywhere between 116 and 236 systolic and 46 and 120 diastolic. She also has AF. I called the paramedics on Wednesday, they took her BP and ran an ECG and took her by ambulance to the hospital where she sent home the next day with instructions to take 5mg of Ramapril instead of the 2.5mg she was prescribed and to discontinue the benzofluazide. I brought her home on Thursday but she complained that she felt just a bad as she had before she went in. At midnight I heard her calling me. She was confused and rambling. I called 999 and the paramedics thought she may have had a stroke, she has had TIA's before so back to hospital we go. The stroke nurse said that she thought her behaviour was more symptomatic of a UTI than a stroke but she has no infection that they can find either in her blood or urine. As time progressed she became more and more agitated and was screaming in pain, she also vomited solidly for half an hour Eventually they put a catheter in and 700ml of urine came out after which she calmed considerably. The stroke doctor tested her out and said that he thought she had delirium rather than a stroke. I eventually left her still very muddled in her thinking but miles better than she had been. When I went back in today she was completely back to herself and anxious to come home again .... This won't happen until Monday as there are no doctors at the weekend.
However she was sick this afternoon - one minute she was fine, the next she was vomiting - she claimed it was the heat but I have my doubts.
My questions are:
if she had a TIA (i think it was because now she is coherent she tells me her right hand went numb when this all started and was recovered by the time she called me) could this have brought on acute urine retention with delirium or were the two things unrelated?
And she still has the catheter in, will she get AUR again once it is removed?
Also what could be wrong with her since the valve replacement that is leading to weakness and tiredness? Her medication was not reviewed after the op although her Ramapril was drastically reduced after they discovered the stenosis and we have had to wait 4 weeks to see her GP to discuss same..

I am concerned that they will send her home on Monday having done nothing to solve her problems.
Posted Mon, 18 Aug 2014 in Hypertension and Heart Disease
 
 
Answered by Dr. Benard Shehu 2 hours later
Brief Answer:
Following causes to feeling tired&weak...

Detailed Answer:
Hi,

I am sorry for the situation your mother is facing.

Getting progressively tired and weak is due to:
- operation she had: need time to recuperate her energy
- diuretics she was using: they might have caused hyponatremia/hypokalemia
- urosepsis she was going through: as it is a severe infection
- possible TIA

Usually, TIA and UTI can occur simultaneously, and there is less chance that TIA might have caused UTI or vice versa.

Once the catheter is removed, there will be reduced risks for UTI.

I recommend to:
- increase the dose of ramipril
- avoid taking diuretics as long as there is no CHF.

Hope it helped!
Dr.Benard
Above answer was peer-reviewed by
 
Follow-up: Does TIA cause acute urine retention with delirium? 51 minutes later
I dont think she has a UTI as neither blood tests nor urine samples have indicated any infection. As a result she has not been given any antibiotics and they were happy to insert a catheter. Is it possible to have a UTI or urosepsis without it showing up in tests?
As far as the tiredness and weakness after the op. Surely she should improve as time goes on not get steadily worse - until I'm concerned enough to call the paramedics. When she was discharged from Papworth she was feeling perfectly well
.
 
 
Answered by Dr. Benard Shehu 2 days later
Brief Answer:
Urosepsis is determined by lab analysis...

Detailed Answer:
Hi back,

Thank you for following up.

Urosepsis is a severe UTI (urinary tract infection), so it is impossible to get a clear urine analysis while doctor diagnosed with urosepsis. There is always presence of infection during UTI or urosepsis.

Usually, the use of catheter is associated with nosocomial (opportunistic) UTI or urosepsis. In other words, there are different mibrobial agents to cause UTI with or without catheter.

With regards to convalesce time, it will depend on the:
- actual patient's health status
- the severity of the disease
- if complications are set (dehydration, electrolytes imbalance, etc)

Hope it answered to your queries! Wish fast recovery!
Dr.Benard
Above answer was peer-reviewed by
 
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