Cautionary tale

Ernie123

My DW, late Stage 6, lives in Memory Care. As progression occurs her posture bending over and balance have become an issue. She forgets to use her walker and has had a series of falls lately. She is going to now use a wheelchair. She has good bone structure, not frail. But last week a more serious fall with significant pain meant a trip to hospital to scan for possible fracture. No fractures, just tissue bruising. 

In addition to Tylenol the Doctor ordered a very low dose of 0.5 mg Hydromorphone for pain four time daily. This is about a quarter of what would be considered a normal low dose. First few days she was sleeping more, which is considered normal and good in the circumstances. But suddenly yesterday she  became non responsive. Couldn’t wake up, couldn’t drink fluids or take meds. Pupils non responsive to light. I was called in. Very scary stuff to me. The nurse was trying to awaken her with pain stimulation, no response. Definitely getting dehydrated, but vitals were ok. Ambulance to hospital. By then she had opened her eyes and tried to talk. IV immediately. ER Doc immediately suspected drug overdose but did full series of blood, urine, X-ray, Cat scan to rule out other issue. Nothing found.

Lesson of the day: Doc said he has seen this before in elderly people who are sensitive to opiates. Even a tiny dose, in this case a quarter of a normal low dose, will accumulate and build up as it takes a day or two for the drug to clear the body. Some individuals metabolize more slowly. Some are more sensitive leading to essentially a drug overdose. This could have been much more serious. A cautionary tale I thought worth sharing if your LO is ever prescribed an opiate for pain. Monitor carefully!

Ed1937

Ernie, I know how scary that was. I'm sorry you had to do that. Hopefully things will be better now.

sandwichone123

It's reasonable to ask for Narcan (to reverse opioid overdose) with *any* opioid prescription. In some states, pharmacists are instructed to dispense Narcan with every Rx, in some states it's available without a prescription, and it may still be prescription only in some.

If your loved one is at home, make sure to lock up narcotics and don't tell people you have them. There are some scary stories out there.

Ernie123

Chapter two: Back to the ER by ambulance last night. Acute bladder retention, she couldn’t pee! And the staff had been trying to rehydrate her. Catheter installed on a temp basis. Doctor said the bladder retention is also likely due to the slow buildup of the low dose Hydromorph. Should be ok in a few day’s . Fingers crossed. Much more alert, able to talk, calm which is a blessing. Not upset at all by visiting ER.

As for using Narcan on her first visit when she was non responsive, the doctor said they are reluctant use it with dementia patients as it brings them around too abruptly and often causes agitation. Better to let her body slowly clear if there is no danger of serious complications. Her vitals were fine so hydrate well and let it clear over a day or two.

Lesson: watch your LO very closely if using hydromorph for the first time.