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RESPIRATORY, METABOLIC ACIDOSIS with RA, MIXED CONNECTIVE TISSUE DISORDER.

Resolved Question:

My mother is 82 and has RA and Mixed Connective Tissue Disease. The most prominent feature being Myositis so extreme weakness including the diaphram.

She fell two weeks ago and fractured her sacrum. In the meantime she developed fungal esophogitis and they discovered ovarian cancer for which she had surgery last Thursday.

According to the xrays they do not know if she has pneumonia although the xray is hazy. Her wbc is 24000. Two days ago I was called because during a breathing treatment she became unresponsive temporarily and had a PH of 7. they indicated later that she did have respiratory acidosis and mild metabolic acidosis. She is very congested and due to the weakness having difficulty coughing. They have had to suction mucous out because she really cannot cough it out on her own.

Over the past two days they have been able to take the cpap off for about 2 to 3 hours at a time. Then her co2 goes up again or her blood pressure goes to 200/120 or her heart rate goes to about 145. Do then they put it back on her. I think that they have slightly lowered the settings over the past two days.

She has been very clear with a dnr but can a patient come back from all of these things? The hospital is excellent, I have no issues it seems one dr. is being overly optimistic and the others are not as optimistic so very mixed messages.
 

Category: Family Physician-GP

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Category: HIV- AIDS Specialist
 24 Doctors Online

Hello,
Thank you for your query at DoctorSpring.com
Ideally the sugar levels while fasting should be around 70-110.
And once you eat it can vary between 100-180 after 1 hour, and subsequently due to the action of insulin comes down to 80-140 after 2 hours. Beyond that the blood sugar levels should be below 140, however some doctors recommend even below 180 ( done at any random point of day is normal ).
So seeing your values they are never really going up and you are suffering from bouts of hypoglycemia, especially 66 at 3 hours is very low. That is what is causing the symptoms.
Can you give me a brief medical history? Any history of T2DM/ Systemic Hypertension/ Bronchial Asthma in the family? Are you on any kind of medications? Can you briefly mention about your diet?
Regards.


Patient replied :

My diet is protein, veggies, low glycemic. Hashimotos, and pacemaker which I only use 1% of the time. What causes hypoglycemia?


Hello,
Yes your diet lacks in adequate carbohydrates and that is leading to your hypoglycemic episodes.
Hypoglycemia ( low sugar levels ) are considered to be more dangerous than hyperglycemia ( high sugars ) and has to be corrected.
So I will advise you to see an endocrinologist who can discuss your diet with you and also evaluate the hashimotos status.
Your diet needs to have a balance between proteins and carbohydrates.
Regards.


Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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