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Dr. Ravoof
Dr. Ravoof, Doctor
Category: Medical
Satisfied Customers: 3830
Experience:  Experienced Physician in the field of Medicine and Surgery.
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My MOm is in hospice at home...94 yrs old ...renal failure

Customer Question

My MOm is in hospice at home...94 yrs old ...renal failure for 2 yrs with no treatment...also pulmonary hypertension and using 4 L O2 continuous and high bp...has been doing well for 2 yrs..last week hospice nurse stopped her Bumex because the nurse said
she was not eating or drinking enough....we have had problems in the past with fluid build up and it took a while to get meds right ....bp meds and duretic...now 5 days after stoppage of bumex she has pronounced shortness of breath so the nurse wants her to
use morphine...we ar all against it and want her to use the bumex again...we realize she is old and sick but feel she needs that diuretic...and also realize that morphine is used very frequently in hospice situations....that would be ok for pain but my Mom
has no pain..
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. Ravoof replied 1 year ago.

Dear customer,

Basically what your mother needs is a consultation with a doctor for second opinion. This is because Bumex is known to cause electrolyte imbalances which may be dangerous. Hence her charts and investigations need to be reviewed and if at present there is no electrolyte disturbance or dehydration then your doctor may restart the Bumex and this will be beneficial.

Take care.

Expert:  Dr. Ravoof replied 1 year ago.

Dear customer,

Regarding morphine you need to also discuss this medication with your doctor since the risks of morphine may outweigh its benefits in the treatment of pulmonary edema, however it may be beneficial to use it sometimes to relieve the shortness of breath and anxiety.

Take care.

Expert:  Dr S.A.Alam replied 1 year ago.

Thank you for your question, only diuretic that has shown to decrease the mortality and reduce the symptoms is spironolactone in her case, she needs oxygen, plus spironolactone and sildenafil. Morphine can also be used to lower the pulmonary pressure but it is highly addictive and only used in hospital. Let me know if you have questions, Thank you. Do rate as positive, have a nice day. In her case if you stop diuretic she will land up with severe right heart failure secondary to pulmonary hypertension.

Expert:  Dr. Ravoof replied 1 year ago.

Dear customer,

Thanks for your question.

Basically what your mother needs is a consultation with a doctor for second opinion. This is because Bumex is known to cause electrolyte imbalances which may be dangerous. Hence her charts and investigations need to be reviewed and if at present there is no electrolyte disturbance or dehydration then your doctor may restart the Bumex and this will be beneficial.

Regarding morphine you need to also discuss this medication with your doctor since the risks of morphine may outweigh its benefits in the treatment of pulmonary edema, however it may be beneficial to use it sometimes to relieve the shortness of breath and anxiety.

Take care.

Please rate the answer with an excellent five star rating.

Thanks.

Expert:  Dr. Ravoof replied 1 year ago.

Dear customer,

Regarding spirinolactone this needs to be given only in consultation with her nephrologist since in renal impairment the dosage needs to be monitored and most doctors will avoid spirinolactone since it is contraindicated when there is significant impairment of renal excretory function. However Bumex may be useful when there is fluid retention with impaired renal function.

Take care.

Expert:  Dr S.A.Alam replied 1 year ago.

http://www.escardio.org/Guidelines-&-Education/Clinical-Practice-Guidelines/Pulmonary-Hypertension-Guidelines-on-Diagnosis-and-Treatment-of

Above link is of latest guidelines which are for pulmonary hypertension, these are jointly followed by AHA and ESC.

spironolactone unless contraindicated, oxygen, sildenafil, ERA are class 1 medicine for pulmonary hypertension.

Let me know if you have questions.

Expert:  Dr. Ravoof replied 1 year ago.

Dear customer,

This is the reason that a second opinion from another doctor is indicated in her case. Her case is not very simple as she is suffering from renal failure and this complicates most treatment options, and though some drugs which are clearly beneficial and indicated according to latest guidelines are contraindicated in her case. Therefore her doctor needs to keep all her preexisting conditions in mind before planning her treatment.

Take care.

Expert:  Dr S.A.Alam replied 1 year ago.

CKD has 4-5 grades and unless creatinine clearance and potassium levels are above certain levels spironolactine is still the best option because of mortality benefit.

Expert:  Dr. Ravoof replied 1 year ago.

Dear customer,

Please take another opinion and proceed with the doctors advice. Since here we do not have all the investigations we cannot know which medication is contraindicated and in which stage of kidney disease your mother is.

Take care.

If no further question, please rate the answer with a five star rating.

Thanks.

Expert:  Dr S.A.Alam replied 1 year ago.

Let me know if you have questions, thank you.

Expert:  Dr. Ravoof replied 1 year ago.

Dear customer,

If no further questions, you may rate the answer above with an excellent five star rating.

Thanks.