Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment To Prevent CHF Exacerbations
Question: 77 year old CHF/COPD/DM1 admitted for CHF exacerbation. currently on BIPAP, pitting edema builateral legs.
( my grandpa) his pulmonologist will not give him steroids, stopped giving lasix c/t hypotension but are not giving dopamine/dobutamine for his pressure. Any ideas? I want him to get a PICC, continue LAsix- K+ replacement (he is twitching think his K+ is low) start dopamin/dobutamine for his pressure and possibly get 25gms IV albumin daily for a few days to help resolve third spacing..... thoughts?
Brief Answer:
BIPAP is right, no need for steroid and albumin
Detailed Answer:
Hello XXXX,
Thanks for your query. I admire your concern regarding your grandpa.
As its a CHF exacerbation not a COPD exacerbation there is no need to give him so much high dose of steroid in the face of DM1. BIPAP itself will take care of the heart failure and even if the hypokalemia is there it will be corrected as Lasix is stopped which is an etiology for low potassium. Moreover the low potassium level has to be confirmed by blood biochemistry tests. If there is severe fall of blood pressure then only dopamin or dobutamin can be given. I think your doctor is monitoring him well and observing his closely than anyone could have this moment and takes all these steps rightly in this circumstances. Don't worry too much.
If you have further queries you can write back to me.
Thank you.
Regards
Dr Arnab Maji
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
they want to discharge him from the hospital.... before he was on 3 l n/c. now he can not maintin above 88 with 5 liters, bipap he is at 93....
What can we do to prevent it from happening again. It seems he is constantly having chf exacerbations, he takes his lasix and K+ replacement. the DM1 is not an issue I am an ER RN and a diabetic educator. I have adjusted his insulin many tiems for him before. It seems when he is on the steroids he does great. he is himself, in sted of how he is now. I dont want him to have a high dose of steroids, mayb 5-10mg daily just to see if it helps, if not after a week or so then we can taper down and stop. I am speakign to the pulmonologist later today and want to have all my info. they wouldnt tell me his labs last night at the hospital. im hoping today i can see him CMP results. I am expecting his K+ to be low. He ended up getting an irregualr heart beat for a while last night. now back to sinus. there has to be a way to prevent it from keep happening. i know albumin is supposidly contraindicated, but that is the only thing i know of to fix third spacing. What else is there. He cant have more diuretics since he is hypotensive. they wouldnt put him on a pressor. mayeb today they will. I wanted to ask him pulm. for low dose steroids, and albumin for a few days, plus maybe a d5/.09 k20meg. sicne he isnt eating and will most likley need more potassium. i dont want to be a typical healthcare worker family member but it just seems this md is giving my grandparetns a hard time. they will do what ever he says without question, and me being from a magnet hospital, i am encouraged to question everything.
What else are some options other than just diuretics and wait....
Brief Answer:
COPD medications, diuresis, home NIV, Kcl syrup
Detailed Answer:
Thanks for writing back.
CHF and COPD can exacerbated simultaneously and this very much difficult to distinguish them but NTproBNP level may distinguish between them. It is elevated in CHF and CHF is a very common co-morbidity in COPD because of diastolic dysfunction and many a times it is chronic but may improve with improvement of FEV1. So you please mention the level of his COPD control and mention his COPD medications with dosage. This BIPAP machine you can use at home. Home NIV is a very good solution. If long term oxygen therapy is needed you can have an oxygen concentrator to raise SpO2 above 90%. With this heart failure will also improve. Is he taking insulin?
In this scenario some COPD medications, insulin all can cause hypokalemia which needs to be properly addressed and managed. Home NIV and oxygen concentrator is indeed of help in this scenario. If inhaled beta agonist or theophylline is taken by him, it may make him hypokalemic. Too much diuresis may also cause hypokalemia. In that case potassium sparing diuretics may have to be used. These are the issues which are needed to be properly addressed and managed.
Thank you
Regards
Dr Arnab Maji
Pulmonologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
