Mum's sodium levels sky high, infection, dehydration. Is CH at fault?

[SarahL]

Hi everyone

I wrote last week very worried about my Mum who was very sleepy and deteriorating rapidly. I wasn't sure if this was caused by sudden progression of her disease. I had been trying to check out her meds previously as she seemed sedated all the time - however her sleeping suddenly became increased, she wasn't eating and could not formulate any words etc.

I was especially concerned about her not eating and the care home told me the food was remaining in her mouth as she wasn't swallowing; I noticed there were a lot of food remnants round her mouth and moisture/food dribble under her chin which was causing her neck to be red and sore and I had asked a couple of times about her welfare and meds. One of the nurses said they had requested a blood test the previous Friday and on Tuesday when I asked again they said they were waiting for a form to complete. One of the carers told me 'it was the disease progressing'.

I had replies from some lovely people on here last week but want to let you know that on Thursday night the care finally home got the blood tests back which showed Mum's sodium levels as very high and she was admitted to hospital with severe dehydration and an infection. I sat with her for 5 hours in A&E before going to an assessment ward. This has caused me a lot of distress not to mention her, bless her. She is now in a ward and remaining in hospital at the moment.

When she was first admitted to the assessment ward after A&E they could not find her papers which the care home said they sent; they also had no medications for her as these were not sent. I do feel upset about this as if she did not have me advocating for her and supporting her she would be alone with no-one to explain about her. Can I ask if anyone thinks the bloods should have been done sooner for Mum so that she did not get to such a state of dehydration and should I take this up with the care home. I have already spoken to them about the paperwork which they said was sent and may have got mislaid in A&E on the night? I also feel upset the carer told me it was just the disease progressing as they are not experts to make this observation particularly when she was severely dehydrated and ill.

Any thoughts? Many thanks, Sarah

 

[canary]

It seems to me that there are 4 problems - infection(UTI?), dehydration, high sodium levels, and very poor swallow reflex.

Sometimes it can be difficult to know which came first and what is as a result of other things.
It may be that the poor swallow came first - it is usual in late stage dementia and could be the reason for the dehydration, which could, in turn have led to the high sodium levels and infection.
It could have started with an infection and this led to increased confusion and an unwillingness to swallow
It might have started with dehydration causing confusion and an unwillingness to swallow.

I'll tell you the story of my mum, which I hope you may find helpful. Its not exactly the same as she had an injury rather than an infection, but there were multiple factors going on.

Mum with advanced Alzheimers had a fall and fractured her hip. She had it repaired under a GA and it was looking like she was making a good recovery when she suddenly stopped eating and drinking. If you tried to feed her she would clamp her mouth shut or let it dribble out of her mouth and she said that food made her feel sick. She had a blood test and her calcium and sodium levels were very high. She was referred back to the hospital where she had her hip op and she was severely dehydrated so she was put on a drip to rehydrate her. I was told that her problems were due to the extra calcium that she had been given after her op (it was intended to stimulate bone growth) making her feel sick and once the calcium was gone out of her system she would not be feeling sick and she would be less confused once she was rehydrated. So the hospital expected her to be back to where she was before the fracture and discharged her back to her care home.

Unfortunately, it was not to be. Even after her calcium and sodium levels returned to normal mum would still not swallow anything. She was seen by her GP and he had a very long and compassionate, though very frank, conversation with me. He said that in his opinion the fracture and op had advanced mums dementia to end stages and she had lost her swallow due to this. He said that her body was slowly shutting down and had probably been doing so since the op and this was the reason for everything else. Mum was placed on palliative care.

I am not saying that your mum is the same @SarahL What I am saying it that the reason for things is not always obvious to start with. Your mum is in hospital and they will probably rehydrate her and give antibiotics to treat the infection. After this they will probably know what is going on.

((((((((((((((((((hugs))))))))))))))))))))))))

 

[love.dad.but..]

Things can take an unexpected downturn very quickly. I visited dad every other day in his NH. Although declining to the stage of not wanting to eat much or drink I know from what I saw on my visits and read on his daily food and fluid charts and from my persistent attempts on my visits to particularly get dad to take fluids how difficult it was to persuade him. His what and why for food and fluids had gone. Within 24 hours of me visiting dad had a day of appearing off colour and my next visit the day after ....he collapsed when I arrived. He had become suddenly dehydrated...high sodium level...urinary infection causing sepsis and porobably had a tia. The consultant questioned whether he had been given enough fluids by his NH....I could honestly say yes he had been given many regular opportunities and prompts...the sudden and speedy acute attack on his system just completely took over...he was in hospital for a week on iv fluids and ABs and after a lengthy candid and compassionate discussion with the consultant then end of life care in his NH for a week until he passed away. I knew he wouldn't maintain independent fluids in his NH but neither could he stay on iv support indefinitely his body just shut down. It wasn't a case of us giving up on dad his body was giving up on him and this was also as a direct result of his brain being unable to make a simple choice of needing to drink. Hopefully the hospital intervention will help your mum. Your question is probably something that can only be asked of the medics and care home as circumstances are so individual for each person who suffers a dramatic sudden downturn.

 

[Theresalwaystomorrow]

My experience is that some NH can be reluctant to call in local GP for second opinion, it’s as if they are saying ‘we can cope ‘
That’s my experience with our NH and we are going to raise this at our Best Interest meeting.

 

[acorns]

My mother was also taken to hospital in June with sepsis, severe dehydration, high sodium and inflammation levels. To cut a long story short she survived to fight another day that time. After about 6 weeks her appetite returned and for a while she seemed better than she's been for a long time. I thought about the end stage dementia rollercoaster often mentioned here - and remembered someone said they'd had 19 hospitals admissions or scares during that time. She had a shorter hospital admission for infection a week or so ago having been unresponsive again. Now this week she's having trouble swallowing and choking on food again and not eating - so we're back to stage one.

Like you I really want to ask for a blood test to check for infection and hydration levels - ideally every week - but the doctor tends to like to leave things for a while. Mum is at home with me so same problems in different environment.

I'm not sure how things work at care homes - but can you not contact the dr yourself? I copied and pasted all the symptoms for sepsis, aspiration pneumonia, dehydration etc so I'd have them handy. If you could prove that your mum ticked some of those boxes maybe they'd have to act sooner. Could you also visit more often but for shorter visits? Then you'll be more likely to see changes more quickly. I hope she picks up again soon and that you can persuade the staff to be more vigilant.