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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Management Of Interstitial Lung Disease With Kidney Failure

Dad is at the end of his fight with interstitial lung disease. Kidneys are failing hospice nurse says. No significant food or water for 2 days. He can t really swallow well. Yesterday we started .25 doses of liquid morphine every 2 hours or as needed. So far except for sleep times that is what we have used. Today, this afternoon, about 7, he began muscle contractions or tremors, myoclonus, I guess. I read that that was normal at this stage, but Mom was worried and called his caregiver in and she gave him two more quick doses of the morphine, saying it was pain. I disagree. It is involuntary. So since 6:30est he has had three doses. His tremors increased it seems. We gave him a little ativan and he is finally settling down. Harriet the caregiver and mom and sister are outside talking now. As she left, she said keep giving hims this...pointing out the morphine. And the ativan. If he doesn t settle down. I disagree with the morphine, but think another low dose ativan wouldn t hurt if he doesn t says asleep. Your opinion?
Wed, 24 Sep 2014
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Pulmonologist 's  Response
Hi,
Interstitial lung disease is a progressive lung disease for which unfortunately, we do not have a "cure" till date. Considering your dad currently has kidney failure further complicates the things as it limits our options of medications available for the disease. Interstitial lung disease per say does not cause chest pain but leads to chest discomfort and breathlessness. Morphine may have been initiated to symptomatically comfort him. Adding ativan for sedation will require clinical monitoring and such a patient needs strict clinical supervision. You need to be cautious as giving ativan in respiratory failure may lead to respiratory depression also.
Respiratory support ,oxygen therapy and management of comorbidities should be focused on.
Further clinical care in supervision of a pulmonologist is recommended.
Regards
Dr. Mishra
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Suggest Management Of Interstitial Lung Disease With Kidney Failure

Hi, Interstitial lung disease is a progressive lung disease for which unfortunately, we do not have a cure till date. Considering your dad currently has kidney failure further complicates the things as it limits our options of medications available for the disease. Interstitial lung disease per say does not cause chest pain but leads to chest discomfort and breathlessness. Morphine may have been initiated to symptomatically comfort him. Adding ativan for sedation will require clinical monitoring and such a patient needs strict clinical supervision. You need to be cautious as giving ativan in respiratory failure may lead to respiratory depression also. Respiratory support ,oxygen therapy and management of comorbidities should be focused on. Further clinical care in supervision of a pulmonologist is recommended. Regards Dr. Mishra