My Mother in Hospital

[Landy]

My Mom (non CF) is in the hospital and sounds just terrible. Rattley cough, she is disoriented and can't stay awake. Supposedly she has pneumonia, but I'm wondering if she has fluid around her lungs/heart due to her congestive heart failure? Or both.

OK...here's my question. I have not made it to the hospital because I really don't want to get pneumonia, but I have called dad & tried to talk to mom, to no avail--she sounds like she's been drinking non-stop for 3+ days (and she doesn't even drink).

I called the nurse this a.m. and asked her if they did a blood gas and she said they just did this a.m. & her CO2 was 61 and they think she was getting too much O2 and that's why CO2 level is high, so they bumped her O2 down to 1 liter (from 3). Does this sound like a plausible solution? How else can CO2 levels be brought down? I wondered about a bi-pap?

Also, if she does have fluid retention, is that not tested by checking kidney function, or is there another test??

Thanks so much for any/all information you can provide and if I may ask, any prayers on her behalf would be appreciated too!

edited due to spelling errors<img src="">

 

[Landy]

My Mom (non CF) is in the hospital and sounds just terrible. Rattley cough, she is disoriented and can't stay awake. Supposedly she has pneumonia, but I'm wondering if she has fluid around her lungs/heart due to her congestive heart failure? Or both.

OK...here's my question. I have not made it to the hospital because I really don't want to get pneumonia, but I have called dad & tried to talk to mom, to no avail--she sounds like she's been drinking non-stop for 3+ days (and she doesn't even drink).

I called the nurse this a.m. and asked her if they did a blood gas and she said they just did this a.m. & her CO2 was 61 and they think she was getting too much O2 and that's why CO2 level is high, so they bumped her O2 down to 1 liter (from 3). Does this sound like a plausible solution? How else can CO2 levels be brought down? I wondered about a bi-pap?

Also, if she does have fluid retention, is that not tested by checking kidney function, or is there another test??

Thanks so much for any/all information you can provide and if I may ask, any prayers on her behalf would be appreciated too!

edited due to spelling errors<img src="">

 

[Landy]

My Mom (non CF) is in the hospital and sounds just terrible. Rattley cough, she is disoriented and can't stay awake. Supposedly she has pneumonia, but I'm wondering if she has fluid around her lungs/heart due to her congestive heart failure? Or both.

OK...here's my question. I have not made it to the hospital because I really don't want to get pneumonia, but I have called dad & tried to talk to mom, to no avail--she sounds like she's been drinking non-stop for 3+ days (and she doesn't even drink).

I called the nurse this a.m. and asked her if they did a blood gas and she said they just did this a.m. & her CO2 was 61 and they think she was getting too much O2 and that's why CO2 level is high, so they bumped her O2 down to 1 liter (from 3). Does this sound like a plausible solution? How else can CO2 levels be brought down? I wondered about a bi-pap?

Also, if she does have fluid retention, is that not tested by checking kidney function, or is there another test??

Thanks so much for any/all information you can provide and if I may ask, any prayers on her behalf would be appreciated too!

edited due to spelling errors<img src="">

 

[Landy]

My Mom (non CF) is in the hospital and sounds just terrible. Rattley cough, she is disoriented and can't stay awake. Supposedly she has pneumonia, but I'm wondering if she has fluid around her lungs/heart due to her congestive heart failure? Or both.

OK...here's my question. I have not made it to the hospital because I really don't want to get pneumonia, but I have called dad & tried to talk to mom, to no avail--she sounds like she's been drinking non-stop for 3+ days (and she doesn't even drink).

I called the nurse this a.m. and asked her if they did a blood gas and she said they just did this a.m. & her CO2 was 61 and they think she was getting too much O2 and that's why CO2 level is high, so they bumped her O2 down to 1 liter (from 3). Does this sound like a plausible solution? How else can CO2 levels be brought down? I wondered about a bi-pap?

Also, if she does have fluid retention, is that not tested by checking kidney function, or is there another test??

Thanks so much for any/all information you can provide and if I may ask, any prayers on her behalf would be appreciated too!

edited due to spelling errors<img src="">

 

[Landy]

My Mom (non CF) is in the hospital and sounds just terrible. Rattley cough, she is disoriented and can't stay awake. Supposedly she has pneumonia, but I'm wondering if she has fluid around her lungs/heart due to her congestive heart failure? Or both.
<br />
<br />OK...here's my question. I have not made it to the hospital because I really don't want to get pneumonia, but I have called dad & tried to talk to mom, to no avail--she sounds like she's been drinking non-stop for 3+ days (and she doesn't even drink).
<br />
<br />I called the nurse this a.m. and asked her if they did a blood gas and she said they just did this a.m. & her CO2 was 61 and they think she was getting too much O2 and that's why CO2 level is high, so they bumped her O2 down to 1 liter (from 3). Does this sound like a plausible solution? How else can CO2 levels be brought down? I wondered about a bi-pap?
<br />
<br />Also, if she does have fluid retention, is that not tested by checking kidney function, or is there another test??
<br />
<br />Thanks so much for any/all information you can provide and if I may ask, any prayers on her behalf would be appreciated too!
<br />
<br />edited due to spelling errors<img src="">

 

[Jane]

Landy I don't have anything to offer as far as answers but I'll be thinking about your mom and hoping for some results.<img src="i/expressions/heart.gif" border="0">

 

[Jane]

Landy I don't have anything to offer as far as answers but I'll be thinking about your mom and hoping for some results.<img src="i/expressions/heart.gif" border="0">

 

[Jane]

Landy I don't have anything to offer as far as answers but I'll be thinking about your mom and hoping for some results.<img src="i/expressions/heart.gif" border="0">

 

[Jane]

Landy I don't have anything to offer as far as answers but I'll be thinking about your mom and hoping for some results.<img src="i/expressions/heart.gif" border="0">

 

[Jane]

Landy I don't have anything to offer as far as answers but I'll be thinking about your mom and hoping for some results.<img src="i/expressions/heart.gif" border="0">

 

[adamsants]

I am the same not much to offer....my dad was diagnosed with pnemonia last night as well and they said he had fluid in his lungs but they gave him a iv for an hour and some oral meds and let him go home.

will say a prayer for your mom

 

[adamsants]

I am the same not much to offer....my dad was diagnosed with pnemonia last night as well and they said he had fluid in his lungs but they gave him a iv for an hour and some oral meds and let him go home.

will say a prayer for your mom

 

[adamsants]

I am the same not much to offer....my dad was diagnosed with pnemonia last night as well and they said he had fluid in his lungs but they gave him a iv for an hour and some oral meds and let him go home.

will say a prayer for your mom

 

[adamsants]

I am the same not much to offer....my dad was diagnosed with pnemonia last night as well and they said he had fluid in his lungs but they gave him a iv for an hour and some oral meds and let him go home.

will say a prayer for your mom

 

[adamsants]

I am the same not much to offer....my dad was diagnosed with pnemonia last night as well and they said he had fluid in his lungs but they gave him a iv for an hour and some oral meds and let him go home.
<br />
<br />will say a prayer for your mom

 

[PedsNP2007]

Landy,

First of all, I work in peds ICU so adult medicine is kinda out of my realm. But here are a couple initial ideas.

Re the fluid: Has she had a chest xray? You can tell a bit from a xray -- you can see fluid around the heart or outside the lungs within the pleural space (pleural effusions).

Has her renal function been checked? Creatinine, BUN? Does she have a low albumin (low albumin can sometimes be indicative of fluid shifts).

Clinically, does she have edema to her feet, her hands... Does she have an enlarged abdomen more than normal? Sometimes when someone has heart failure (which can cause fluid shifts), the liver becomes more distended (right sided heart failure) or there is more fluid in the lungs (left sided heart failure).

As far as the o2 amount causing increased co2... There is a relation between that to some degree. If you give someone more oxygen than they need (ie. on 50% oxygen with 100% oxygen sats versus 30% oxygen with 100% oxygen sats), it can cause some actelectasis (collapse of aveoli that is responsible for oxygen and carbon dioxide exchange). But I doubt that is the case as she is on nasal cannula with 3 to 1 liters per minute... we see more problem with actelectasis with intubated children on high high high oxygen amounts.

Bipap is helpful in decreasing the CO2. It is also helpful if there are areas of lung collapse (alveolar collapse). We also do incentive spirometer (this handheld thing that ask the person to breathe in deeply to increase amount of volume in lung). Bipap can be annoying though since it is a pressurized system. It should be tried prior to any more invasive therapy (ie, ventilator).

ALSO, it is very important to find out the whole blood gas results. If it is a lung issue causing increased CO2, her body will eventually compensate for this with retaining bicarbonate by her kidneys. So if she has a relatively normal pH then it is not critical to quickly try to decrease the CO2. She may have a higher bicarbonate in her system that is buffering the acidity of the CO2. We make no huge changes for children with pH >7.30 (normal 7.35-7.45) even if their CO2 are 60-70's (normal 35-45) as they can compensate with bicarb in the 30-40's (normal is 20-25).

It's not good to be very acidotic in the body, but it is ok to have some acidosis with compensation. It is not good to correct to the point that the body is alkalotic... less ability to release oxygen to tissues if the body chemistry is alkalotic. It's a fine balance

It's so hard to find out what is going on without being there and examining the pt. I hope I didn't overwhelm you with this. Feel free to ask more questions.

Jenn
30 yo cf

 

[PedsNP2007]

Landy,

First of all, I work in peds ICU so adult medicine is kinda out of my realm. But here are a couple initial ideas.

Re the fluid: Has she had a chest xray? You can tell a bit from a xray -- you can see fluid around the heart or outside the lungs within the pleural space (pleural effusions).

Has her renal function been checked? Creatinine, BUN? Does she have a low albumin (low albumin can sometimes be indicative of fluid shifts).

Clinically, does she have edema to her feet, her hands... Does she have an enlarged abdomen more than normal? Sometimes when someone has heart failure (which can cause fluid shifts), the liver becomes more distended (right sided heart failure) or there is more fluid in the lungs (left sided heart failure).

As far as the o2 amount causing increased co2... There is a relation between that to some degree. If you give someone more oxygen than they need (ie. on 50% oxygen with 100% oxygen sats versus 30% oxygen with 100% oxygen sats), it can cause some actelectasis (collapse of aveoli that is responsible for oxygen and carbon dioxide exchange). But I doubt that is the case as she is on nasal cannula with 3 to 1 liters per minute... we see more problem with actelectasis with intubated children on high high high oxygen amounts.

Bipap is helpful in decreasing the CO2. It is also helpful if there are areas of lung collapse (alveolar collapse). We also do incentive spirometer (this handheld thing that ask the person to breathe in deeply to increase amount of volume in lung). Bipap can be annoying though since it is a pressurized system. It should be tried prior to any more invasive therapy (ie, ventilator).

ALSO, it is very important to find out the whole blood gas results. If it is a lung issue causing increased CO2, her body will eventually compensate for this with retaining bicarbonate by her kidneys. So if she has a relatively normal pH then it is not critical to quickly try to decrease the CO2. She may have a higher bicarbonate in her system that is buffering the acidity of the CO2. We make no huge changes for children with pH >7.30 (normal 7.35-7.45) even if their CO2 are 60-70's (normal 35-45) as they can compensate with bicarb in the 30-40's (normal is 20-25).

It's not good to be very acidotic in the body, but it is ok to have some acidosis with compensation. It is not good to correct to the point that the body is alkalotic... less ability to release oxygen to tissues if the body chemistry is alkalotic. It's a fine balance

It's so hard to find out what is going on without being there and examining the pt. I hope I didn't overwhelm you with this. Feel free to ask more questions.

Jenn
30 yo cf

 

[PedsNP2007]

Landy,

First of all, I work in peds ICU so adult medicine is kinda out of my realm. But here are a couple initial ideas.

Re the fluid: Has she had a chest xray? You can tell a bit from a xray -- you can see fluid around the heart or outside the lungs within the pleural space (pleural effusions).

Has her renal function been checked? Creatinine, BUN? Does she have a low albumin (low albumin can sometimes be indicative of fluid shifts).

Clinically, does she have edema to her feet, her hands... Does she have an enlarged abdomen more than normal? Sometimes when someone has heart failure (which can cause fluid shifts), the liver becomes more distended (right sided heart failure) or there is more fluid in the lungs (left sided heart failure).

As far as the o2 amount causing increased co2... There is a relation between that to some degree. If you give someone more oxygen than they need (ie. on 50% oxygen with 100% oxygen sats versus 30% oxygen with 100% oxygen sats), it can cause some actelectasis (collapse of aveoli that is responsible for oxygen and carbon dioxide exchange). But I doubt that is the case as she is on nasal cannula with 3 to 1 liters per minute... we see more problem with actelectasis with intubated children on high high high oxygen amounts.

Bipap is helpful in decreasing the CO2. It is also helpful if there are areas of lung collapse (alveolar collapse). We also do incentive spirometer (this handheld thing that ask the person to breathe in deeply to increase amount of volume in lung). Bipap can be annoying though since it is a pressurized system. It should be tried prior to any more invasive therapy (ie, ventilator).

ALSO, it is very important to find out the whole blood gas results. If it is a lung issue causing increased CO2, her body will eventually compensate for this with retaining bicarbonate by her kidneys. So if she has a relatively normal pH then it is not critical to quickly try to decrease the CO2. She may have a higher bicarbonate in her system that is buffering the acidity of the CO2. We make no huge changes for children with pH >7.30 (normal 7.35-7.45) even if their CO2 are 60-70's (normal 35-45) as they can compensate with bicarb in the 30-40's (normal is 20-25).

It's not good to be very acidotic in the body, but it is ok to have some acidosis with compensation. It is not good to correct to the point that the body is alkalotic... less ability to release oxygen to tissues if the body chemistry is alkalotic. It's a fine balance

It's so hard to find out what is going on without being there and examining the pt. I hope I didn't overwhelm you with this. Feel free to ask more questions.

Jenn
30 yo cf

 

[PedsNP2007]

Landy,

First of all, I work in peds ICU so adult medicine is kinda out of my realm. But here are a couple initial ideas.

Re the fluid: Has she had a chest xray? You can tell a bit from a xray -- you can see fluid around the heart or outside the lungs within the pleural space (pleural effusions).

Has her renal function been checked? Creatinine, BUN? Does she have a low albumin (low albumin can sometimes be indicative of fluid shifts).

Clinically, does she have edema to her feet, her hands... Does she have an enlarged abdomen more than normal? Sometimes when someone has heart failure (which can cause fluid shifts), the liver becomes more distended (right sided heart failure) or there is more fluid in the lungs (left sided heart failure).

As far as the o2 amount causing increased co2... There is a relation between that to some degree. If you give someone more oxygen than they need (ie. on 50% oxygen with 100% oxygen sats versus 30% oxygen with 100% oxygen sats), it can cause some actelectasis (collapse of aveoli that is responsible for oxygen and carbon dioxide exchange). But I doubt that is the case as she is on nasal cannula with 3 to 1 liters per minute... we see more problem with actelectasis with intubated children on high high high oxygen amounts.

Bipap is helpful in decreasing the CO2. It is also helpful if there are areas of lung collapse (alveolar collapse). We also do incentive spirometer (this handheld thing that ask the person to breathe in deeply to increase amount of volume in lung). Bipap can be annoying though since it is a pressurized system. It should be tried prior to any more invasive therapy (ie, ventilator).

ALSO, it is very important to find out the whole blood gas results. If it is a lung issue causing increased CO2, her body will eventually compensate for this with retaining bicarbonate by her kidneys. So if she has a relatively normal pH then it is not critical to quickly try to decrease the CO2. She may have a higher bicarbonate in her system that is buffering the acidity of the CO2. We make no huge changes for children with pH >7.30 (normal 7.35-7.45) even if their CO2 are 60-70's (normal 35-45) as they can compensate with bicarb in the 30-40's (normal is 20-25).

It's not good to be very acidotic in the body, but it is ok to have some acidosis with compensation. It is not good to correct to the point that the body is alkalotic... less ability to release oxygen to tissues if the body chemistry is alkalotic. It's a fine balance

It's so hard to find out what is going on without being there and examining the pt. I hope I didn't overwhelm you with this. Feel free to ask more questions.

Jenn
30 yo cf

 

[PedsNP2007]

Landy,
<br />
<br />First of all, I work in peds ICU so adult medicine is kinda out of my realm. But here are a couple initial ideas.
<br />
<br />Re the fluid: Has she had a chest xray? You can tell a bit from a xray -- you can see fluid around the heart or outside the lungs within the pleural space (pleural effusions).
<br />
<br />Has her renal function been checked? Creatinine, BUN? Does she have a low albumin (low albumin can sometimes be indicative of fluid shifts).
<br />
<br />Clinically, does she have edema to her feet, her hands... Does she have an enlarged abdomen more than normal? Sometimes when someone has heart failure (which can cause fluid shifts), the liver becomes more distended (right sided heart failure) or there is more fluid in the lungs (left sided heart failure).
<br />
<br />As far as the o2 amount causing increased co2... There is a relation between that to some degree. If you give someone more oxygen than they need (ie. on 50% oxygen with 100% oxygen sats versus 30% oxygen with 100% oxygen sats), it can cause some actelectasis (collapse of aveoli that is responsible for oxygen and carbon dioxide exchange). But I doubt that is the case as she is on nasal cannula with 3 to 1 liters per minute... we see more problem with actelectasis with intubated children on high high high oxygen amounts.
<br />
<br />Bipap is helpful in decreasing the CO2. It is also helpful if there are areas of lung collapse (alveolar collapse). We also do incentive spirometer (this handheld thing that ask the person to breathe in deeply to increase amount of volume in lung). Bipap can be annoying though since it is a pressurized system. It should be tried prior to any more invasive therapy (ie, ventilator).
<br />
<br />ALSO, it is very important to find out the whole blood gas results. If it is a lung issue causing increased CO2, her body will eventually compensate for this with retaining bicarbonate by her kidneys. So if she has a relatively normal pH then it is not critical to quickly try to decrease the CO2. She may have a higher bicarbonate in her system that is buffering the acidity of the CO2. We make no huge changes for children with pH >7.30 (normal 7.35-7.45) even if their CO2 are 60-70's (normal 35-45) as they can compensate with bicarb in the 30-40's (normal is 20-25).
<br />
<br />It's not good to be very acidotic in the body, but it is ok to have some acidosis with compensation. It is not good to correct to the point that the body is alkalotic... less ability to release oxygen to tissues if the body chemistry is alkalotic. It's a fine balance
<br />
<br />It's so hard to find out what is going on without being there and examining the pt. I hope I didn't overwhelm you with this. Feel free to ask more questions.
<br />
<br />Jenn
<br />30 yo cf