# Strange Case



## SMButton91 (Aug 28, 2011)

Hello, I was transporting a patient the other day, and was reading her paperwork. Anyways tell me what you think. 

Patient is a retired 65 y/o female that has a history of;
A fib
CHF
Severe Depression
hypertension
severe obesity
Sleep apnea
Seizures
Anxiety
GERD

She decides that her life isn't worth living anymore so she quits taking all of her meds and doesn't go to dialysis treatments. 

Meds: 
Buspar
Clonazapam
Digoxin
Diltiazam
Pantopazole
Venlafaxine
Tylenol PRN 

Anyways about 4-5 days later she develops a kidney stone(not sure what kind, anybody guess?) With that she develops hydronephrosis. Luckily her daughter stops over to visit and notices her with extreme pain to the left flank. She calls 911 and EMS brings her to the hospital. 

Ems notices her lungs sound like a swamp and start cpap, and a nitro drip.  spo2 around 70-80's. On the arrival to the ER she codes with PEA. She's intubated, and luckily they got a pulse back and gets her up to the ICU. 

So she's put back on dialysis, all of her meds, neb treatments if needed, and Bipap. And fast forward to now, 5 months later, and i'm taking her back to a care facility... i'd be depressed too :glare:

Anyways I think its safe to say that, stopping her meds, and dialysis, the kidney stone causing hydronephrosis( which then making it even harder for the body to get rid of fluid, and causing further renal failure), the overload on the heart, and fluid in lungs causing hypoxia.... caused her to code. 

Anything to add? suggest? I'll pry be writing a case study over this. So i'm interested what the experienced medics have to add. ^_^


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## foxfire (Aug 29, 2011)

I am just a newbie when it comes to medic stuff. But here are my two cents worth. 
the untreated renal failure would cause  hypocalcimia and sever acididosis along with the other monkeys in the pot she has going.  when the heart does not have enough calcium the contractility is severly hampered and or none at all. 

I have a few other therories but I will look them up and then get back to ya. 
hopfully some of the medic gurus will be around and answer in a more clear fashion.


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## MrBrown (Aug 29, 2011)

Sounds reasonable


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## Sasha (Aug 29, 2011)

Lady had bad bad bad electrolyte imbalances and fluid overload.

Sucks they got her back, poor lady.

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## bigbaldguy (Aug 29, 2011)

Sasha said:


> Lady had bad bad bad electrolyte imbalances and fluid overload.
> 
> Sucks they got her back, poor lady.
> 
> Sent from LuLu using Tapatalk



Poor lady indeed. There is no death with dignity


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## rmabrey (Aug 30, 2011)

What no DNR?


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## usafmedic45 (Aug 30, 2011)

> the untreated renal failure would cause hypocalcimia



Try again Kemosabe. 



> when the heart does not have enough calcium the contractility is severly hampered and or none at all.



True but probably not what is going on here.



> Poor lady indeed. There is no death with dignity



+1


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## DESERTDOC (Aug 31, 2011)

CHF,HTN and no duretic is surprising to me.

80% of all renal stones are calcium oxylate.  There rest are struvite, and uric acid stones, the later making up the smallest percentage.

The sedentary lifestyle with the digestive issues, does not help her at all with the stones.


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## firetender (Aug 31, 2011)

*Makes you wonder...*

To get her out of pain from her kidney stones you had to prolong the life that she didn't want to continue. Pain kinda messes up one's resolve, doesn't it!

Or does it mean we don't want anyone to suffer short-term so to satisfy ourselves we prolong life to experience a different agony; that of going away and getting pulled back, going away and getting pulled back.

This is where our ability to prolong life clashes with the individual's desire to have a quick, relatively painless passing; we don't let that happen any more.


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## SMButton91 (Sep 2, 2011)

> CHF,HTN and no duretic is surprising to me.



Ah yes, she is on Lasix as well :wacko:


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## usalsfyre (Sep 2, 2011)

Hydro was probably the least of this womans worries. Look up the number one electrolyte imbalance in renal failure and what it makes unstable.

One thing is for sure, she probably needed calcium, but look up why.


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## EMS Patient Care Advocate (Sep 7, 2011)

I find deadly hyperkalemia in these patients.


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## Ramathorn90 (Sep 7, 2011)

My initial hunch was hyper K with an already compromised heart pushed this poor old lady over the fence.

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## EMS Patient Care Advocate (Sep 7, 2011)

Ramathorn90 said:


> My initial hunch was hyper K with an already compromised heart pushed this poor old lady over the fence.
> 
> Sent from my T-Mobile myTouch 3G using Tapatalk



My thoughts exactly. And calcium is number one protector of heart for this


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## epipusher (Sep 7, 2011)

I would be curious to see her ecg prior to the arrest.


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