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    Suggest treatment for pneumonia with sepsis

Posted on Wed, 25 Nov 2015 in Head Injuries
Question: Dear Doctor, If a patient has pneumonia and suspected sepsis but cannot be given regular analgesia because it could mask his ability to recover then would it be possible to administer PRN or stat analgesia (lower or less frequent doses of analgesia) in such a way as to provide some relief from pain but not give the patient too much analgesia? If so, how could this be done, e.g. some sort of monitoring of the patient? I would be happy to try to provide any additional information that you need.
Answered by Dr. Panagiotis Zografakis 21 minutes later
Brief Answer:
the patient can receive analgesics

Detailed Answer:

I don't understand why a patient in pain has to be deprived of analgesic treatment! Analgesic treatment (paracetamol and non-steroidal anti-inflammatory drugs) may mask the fever but the fever is not the only sign a clinician can use to check a patient's progress (or worsening). Perhaps the doctors have other reasons to avoid such treatment like kidney failure or peptic ulcer (a history of gastrointestinal bleeding for example).

A doctor will check the vital signs and various signs from clinical examination to determine the patient's status. Blood pressure, heart rate, respiratory rate, oxygen saturation, urine production, white blood cells count, C-reactive protein, procalcitonin, etc can be used to help the assessment.

Prn treatment will probably produce similar results like regular treatment.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Panagiotis Zografakis 1 hour later
Thank you Dr. Zografakis for the useful information. Would hydromorphone mask a fever? Although the patient has been diagnosed with pneumonia and suspected sepsis, he has been afebrile for many days. Moreover, could hydromorphone mask any of the vital signs such as BP, heart rate, respiratory rate, 02 saturation (the patient is hypoxic), urine producion, WCC (which is above the normal reference range) and CRP (which is extremely high)? There is no history of peptic ulcers. If hydromorphone could mask any of these vital signs then could some other analgesic, e.g., morphine be used?
Dear Dr. Zografakis, I forgot to add that the patient is hypotensive.
Answered by Dr. Panagiotis Zografakis 5 hours later
Brief Answer:
hydromorphone could get things worse

Detailed Answer:
You're welcome!
I didn't consider opioids as treatment options because they are not the first choice drugs. Opioids could affect the patient's status negatively. The blood pressure would further reduced and the oxygen saturation would rather drop.

The most common first choices are paracetamol and NSAIDs. These drugs would only affect the fever. NSAIDs should be also avoided because of the detrimental effect they may have on the kidney function. Hypotension also causes problems to renal blood flow so they should be avoided. It depends on how 'hypotensive' the patient is. If the patient is on severe sepsis or septic shock then only paracetamol used would be uneventful.

Kind regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Panagiotis Zografakis

Internal Medicine Specialist

Practicing since :1999

Answered : 3691 Questions


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