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Forum Name: Miscellaneous Nephrology Topics

Question: HELP URGENTLY SEEKED


 Anonymous - Fri Mar 07, 2003 10:06 pm

TO WHOM IT MAY CONCERN

THE DOCTORS INFORMED MY FATHER THAT THEY HAVE DIAGNOSED KIDNEY FAILURE ABOUT
2 YEARS AGO AND RECENTLY THEY HAVE INFORMED US THAT HE HAS TO GO FOR
DIALYSIS.

ON THE 9TH OF JUNE 2001 HE HAD A MINOR HEART ATTACK, AND WAS DISCHARGED
FROM
HOSPITAL.

MY FATHER (66 YEARS OF AGE) WAS ADMITTED TO HOSPITAL ON THE 23RD OF JUNE
2001 AFTER HE COLLAPSED AT HOME. WHEN HE WAS ADMITTED THEY TOLD US THAT
HE
IS IN A COMA AND THE REASON -HIS KIDNEYS. A WEEK AFTER HE WAS ADMITTED THEY
DIAGNOSED MENINGITIS. THEY DID ALP AND INFORMED US THAT THEY WILL TREAT
HIM
FOR IT. IN THE MEANTIME HE ALSO GOT LUNG INFECTION ASWELL AS DIARHOEA.
THEY HAVE DONE A BRAINSCAN AND EEG ON TWO OCCASSIONS AND THE BRAINSCAN SHOWS
THAT EVERYTHING IS NORMAL BUT THE EEG (THAT TESTS THE BRAINWAVES I THINK),
IS ABNORMAL. THEY HAVE DONE A BRAINSCAN YESTERDAY AND INFORMED US THAT THERE
IS A ABCESS AND IT CAN BE TREATED. THEY DON'T HAVE TO DO SURGERY. THEY
PRESCRIBED MEDICATION FOR THE ABCESS.
TODAY IS 31 DAYS THAT HE HAS BEEN IN HOSPITAL ON A VENTILATOR AND THE
DOCTORS TOLD US THAT HE WILL STAY THE SAME (HE IS STILL IN A COMA AND DOES
NOT REACT ON PAIN OR ANYTHING ELSE. AND WILL NEVER WAKE UP AGAIN. THEY ALSO
SAY THAT WE MUST GIVE IT TIME. HE WILL BE CLUSTERED TO A BED FOR THE REST
OF
HIS LIFE, FEEDED THROUGH A TUBE AND WILL NEVER SPEAK TO US AGAIN.
PLEASE IS THERE ANYONE THAT CAN HELP ME TO GET ANSWERS OR EVEN BETTER
TREATMENT FOR MY FATHER. EVEN IF YOU CAN REFER ME TO SOMEONE, PLEASE I WILL
DO EVERYTHING IN MY POWER TO HELP MY FATHER IN ANY POSSIBLE WAY.
 Anonymous - Fri Mar 07, 2003 10:08 pm

Dear Reitz,

Could you please send me the results of his current lab tests. The coma is usually the result of multiple factors which will show up in the test results. Is it due to uremia, disturbed pH, electrolyte imbalance or a combination of all the above.
 Anonymous - Fri Mar 07, 2003 10:09 pm

Dear Reitz,

First of all, you have all my sympathy, you are going through tough time right now.

I can not answer all your questions fully because the picture is missing some pieces. I do not know why your dad is on the ventilator right now?? Did he sustain any kind of heart or respiratory arrest?? Did his lung infection got so worse and his oxygen levels were so low that the doctors had to put him on the breathing machine??

About the coma, i want to know whether the doctors did any kind of test that prooves that your dad has brain death or not because it looks like they do not have much hope for recovery! What kind of treatment did they do for the brain abscess your dad had??

I also would like to know whether your dad is receiving any medicines through the IV to maintain his blood pressure (did his blood pressure go really down and they had to start him on what is known as vasopressors??)

You also mentionned that the EEG that they did was abnormal, what did they mean by that? Is it too much brain activity or no brian activity at all???

If your dad has brain death, this means that he will be dependant on the ventilator for the rest of his life and he will not be responsive, he will be in a coma for the rest of his life.

The prognosis of these patients (sorry to say that) is poor and no one can tell how long will they remain in coma or when they are going to pass away.

Coma, in your dad's case may be caused by lots of things actually, it is very complicated. Kidney failure may be the cause but this should be corrected by dialysis. The meningitis and the brain abcess may be the cause and according to the bug that caused this meningitis or the abscess your dad should receive antibiotics and the decision to evacuate the abcess is left to the discretion of the treating physician. But if the meningitis is complicated by encephalitis which is inflammation of the brain, the prognosis will be poor also. Abnormal over active brain wave (what is known as epilepsy) may be the cause EVEN IF YOUR DAD DOES NOT HAVE ANY SEIZURES, so it is crucial to know what kind of abnormal brain wave activity he has. Medications some times can cause coma in patients in your dad's age especially some of the newer antibiotics. Your dad might have other medical condition such as liver failure that i am not aware of, or he just might have sustained a stroke (although this should be evident on the brain scan)

Once more, i know that this is very difficult for you, i hope i answered enough of your questions that may be of help and once more if you could answer some of the questions i asked i will be able to help you more.

Good luck for your dad, yourself and all your family.
 Anonymous - Fri Mar 07, 2003 10:13 pm

THANK YOU FOR MAKING THE TIME TO READ MY E-MAILS.

On the 27th of July I e-mailed a letter concerning my father. Today we got the following prognosis. Some of my father'brain cells (they said "brein vate" in Afrikaans)are dead and they cannot do anything for him anymore. They say that is the reason why he does not wake up. They have also taken away the sedation.

They also said his protein is 5mg. His uremia is 8 and creatinine is 300.

The reason why he is on a ventilator is because of his lungs. They are gradily taking him off the ventilator because they say he can almost breath on his own. My father is definitely not brain dead they have confirmed that today.

His general condition is good.

They also confirmed that the reason for my dad being in a coma is because of the meningitis he had. They did another LP and said that it shows that the meningitis is gone and there is no further signs of the meningitis.

They also did tests that showed that my father did not/or does not suffer from epilepsy.

PLEASE HELP ME ALL I WANT TO KNOW IS IF THERE IS ANY TREATMENT/HOPE OR ANYONE WHO CAN OR KNOW OF SOMEONE WHO CAN HELP MY FATHER.

PLEASE CONTACT VANESSA ON (012) 332-0268 OR CELL: 0828232064 OR E-MAIL reitzp@mweb.co.za.
 Dr. Yasser Mokhtar - Fri Mar 07, 2003 10:14 pm

User avatar Dear Reitz,

Sorry for being late,

First of all, let me tell you that i will not be able to tell you anything about your dad's prognosis.

Second, the doctors saying that part of his brain cells are dead means (in my opinion) that he had a stroke, because there is no other explanation. And according to the area of the brain affected, your dad may or may not regain consciousness. And unfortunately there is no treatment for dead brain cells and unfortunately they do not regenerate.

i want to ask how many times did your dad have dialysis because a BUN of 300 is very high and this means that his may need more dialysis because increase in the BUN at such high levels may cause disturbance in the level of consciousness. If there is no nephrologist (kidney specialist) who is helping in the management of your dad's case, i would encourage you to get a nephrologist involved.

Regarding to him being in a coma secondary to meningitis complications is something that can happen and is not uncommon especially if the inflammation reached the brain surface and in the condition of your dad because he has renal failure, his immunity is low (because most of renal failure patients have low body immunity). And once more, since the most important thing is the conscious level of your dad and whether he will remain in coma and for how long, i would encourage to you, if not already the case, to involve a neurologist (brain and nervous system specialist) in the management of your dad.

To me, it looks like your dad is doing very slow headway and improvement. Trying to get him off of the ventilator means that his lungs are improving even if this improvement is slow.

Last, thank you for putting trust in us and sorry for not being of much help because hearing is not like being involved in the direct care of a patient.
 Anonymous - Fri Mar 07, 2003 10:15 pm

Dear Colleagues,

Let me introduce myself briefly. My name is Mark A. LaGatta and I am a young nephrologist who started private practice recently. My interests are many and varied and I hope to share, exchange and receive medical opinions from other nephrologist.

I would like to start by saying that in the last reply dated February 2001 to the case of the Afrikaans man with meningoencephalitis, that the second letter on the part of the family stated that the creatinine was 300 and the BUN was merely 8. The creatinine was expressed in units other than mg/dL (probably mmol) and is in the normal range, the BUN is slightly depressed. The clinical case seems to suggest the patient arose from a comatose state without the need for supportive dialytic therapy which leads me to believe the renal failure was acute or acute superimposed on chronic.

Warmest Regards,

Mark A. LaGatta

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