Thursday Night

Hello Everyone-

I just got back from the hospital and here's the newest update. I'd like to expand my vocabulary. I've said update so many times that it's losing its meaning... Ok, I spent 30 seconds trying and www.thesaurus.com offers no help. Anyway. Here's the latest.

My dad started dialysis around 7:00 pm. It seemed to be going well. At one point there was a blood clot in one of the lines, but the tech told my uncle Dave that it was not a problem. He would just have to run the machine for an extra 20 minutes or so. After Danny and I left the ICU waiting room where we had been sitting with Dave, my mom, Amy and my uncle John, Dave went back into my dad's room. So I'm not sure if anything has come about since we left.

We were told that my dad still has pneumonia, and if it progresses any farther, he will have what is known as ARDS: Acute Respiratory Distress Syndrome. It is being treated with antibiotics, but Amy said that my dad's doctor said that right now, my dad does not have ARDS. He'll be able to see the newest results with an x-ray tomorrow.
Webmd, what do you have to tell us about ARDS?

Acute respiratory distress syndrome (ARDS) is a type of severe, acute lung dysfunction affecting all or most of both lungs that occurs as a result of illness or injury. Although it is sometimes called adult respiratory distress syndrome, it may also affect children. Major symptoms may include breathing difficulties (dyspnea), rapid breathing (tachypnea), excessively deep and rapid breathing (hyperventilation) and insufficient levels of oxygen in the circulating blood (hypoxemia). ARDS may develop in conjunction with widespread infection in the body (sepsis) or as a result of pneumonia, trauma, shock, severe burns, aspiration of food into the lung, multiple blood transfusions, and inhalation of toxic fumes, among other things. It usually develops within 24 to 48 hours after the original illness or injury and is considered a medical emergency. It may progress to involvement of other organs.

Treatment for ARDS from pulmonologychannel.com


Treatment for ARDS from www.ards.org

There are no currently established medication treatments for combating ARDS itself. Use of steroids, whether through inhalation therapy or otherwise, has been advocated and studied. Certain studies have ruled out various other medication treatments as being ineffective. Some studies are underway to determine the efficacy of other medication therapies. Most medication treatments are oriented toward the underlying medical problems which the patient is battling, such as sepsis and trauma. In addition, other common medications which may be employed during the battle with ARDS include sedating drugs, paralyzing drugs, anti-anxiety medication, and antibiotics to combat or stave off infections. These medications do not directly battle ARDS in a medical sense, rather they are supportive in the battle against ARDS to allow the lungs to heal in hopefully the best medical and physical situation possible considering the underlying medical problems and the severity of the ARDS.

My dad is already on a respirator and on sedating and paralyzing drugs because of the breathing tube they're using to help his COPD and emphysema. They're also treating him with antibiotics.

Amy just sent me a text message saying that they're moving my dad to another room in the same ICU where he'll get a 1 on 1 patient to nurse ratio. She said that his blood pressure was low and they needed a nurse to monitor him constantly. She didn't give any other reasons for the move, and since they're doing it right now, I don't think they'll get one for awhile.



Also: we've been hearing that my dad probably has Seratonin Syndrome, as opposed to Neuroleptic Malignant Syndrome. Seriously, we're not sure. But here's some Seratonin Syndrome info from the Mayo Clinic. I've been trouble finding good information about it.



Original Article:

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Serotonin syndrome

Introduction

Serotonin syndrome is a condition characterized by dangerously high levels of serotonin — a chemical produced by nerve cells — in your body.

Serotonin syndrome can occur when you take certain combinations of prescription medications that affect serotonin levels in your body. For example, serotonin syndrome can occur if you take selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs) for depression along with triptan medications to treat migraine. Serotonin syndrome can also occur if you take SSRIs with other drugs or supplements that affect serotonin levels, such as St. John's wort.

Signs and symptoms of serotonin syndrome range from restlessness and rapid heartbeat to muscle rigidity and seizures. These go away quickly with treatment, which may include discontinuing use of the medications causing the symptoms along with taking other drugs such as muscle relaxants and serotonin-production blocking agents. If not treated quickly, serotonin syndrome can become life-threatening.

Signs and symptoms

Signs and symptoms of serotonin syndrome typically occur within several hours of taking a new drug or taking a previously used drug at an increased dosage level, and may include:

• Extreme agitation or restlessness
• Confusion
• Hallucinations
• Loss of coordination
• Fast heartbeat
• Rapid changes in blood pressure
• Fever
• Heavy sweating
• Overactive reflexes
• Nausea, vomiting and diarrhea
• Seizures
• Coma

Causes

Your nerve cells produce serotonin as a normal part of their functioning. Nerve cells in your brain and spinal cord (central nervous system) produce serotonin that helps regulate your attention, behavior and body temperature. Other nerve cells in your body, primarily in your intestines, also produce serotonin. In these other areas, serotonin plays a role in regulating your digestive process, blood flow and breathing.

When your body has too much serotonin, typically from taking too much medication that affects serotonin levels, the excess can cause serotonin syndrome.

Serotonin syndrome generally occurs when you take multiple drugs that affect serotonin levels in your body. In particular, taking an selective serotonin reuptake inhibitor (SSRI) along with triptans, a class of migraine medications, may cause the condition — potentially raising serotonin to dangerous levels.

However, serotonin syndrome can also occur when you start a single new drug that affects serotonin levels or when you take an increased dose of such a drug that you've previously used. Many drugs may lead to serotonin syndrome. These drugs include but aren't limited to:

• SSRIs such as citalopram (Celexa), fluoxetine (Prozac, Sarafem), fluvoxamine, paroxetine (Paxil) and sertraline (Zoloft)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as trazodone (Desyrel) and venlafaxine (Effexor)
• The norepinephrine and dopamine reuptake inhibitor (NDRI) buproprion (Wellbutrin, Zyban)
• Monoamine oxidase inhibitors (MAOIs) such as isocarboxazid (Marplan) and phenelzine (Nardil)
• Pain medications such as fentanyl (Sublimaze), meperidine (Demerol), pentazocine
  (Talwin) and tramadol (Ultram)
• Anti-nausea medications such as granisetron (Kytril), metoclopramide (Reglan) and ondansetron (Zofran)
• Anti-migraine medications such as almotriptan (Axert), naratriptan (Amerge), sumatriptan (Imitrex) and zolmitriptan (Zomig)
• Over-the-counter cough and cold medications containing dextromethorphan (Robitussin DM, Sudal DM)
• Illegal drugs such as Ecstasy, LSD and Syrian rue
• Herbal supplements such as St. John's wort and ginseng
• Lithium (Eskalith, Lithobid)

Screening and diagnosis

No single test can confirm a serotonin syndrome diagnosis. Your doctor will diagnose the condition by ruling out other possibilities.

Your doctor will likely start by asking about your medical history and any medications you're taking. Serotonin syndrome can mimic other conditions: for example, neuroleptic malignant syndrome — a condition that can occur following use of certain tranquilizer (neuroleptic) drugs — or an overdose of cocaine or an MAOI.

To rule out other conditions, your doctor may use tests that measure any other drugs you're using or abusing, check your hormone levels, and assess key body functions that may be affected by serotonin syndrome.

To be diagnosed with serotonin syndrome, you must be taking a drug that can affect your body's serotonin levels and be experiencing three of the following:

• Agitation
• Uncoordinated movements
• Heavy sweating not due to activity
• Diarrhea
• Overactive reflexes
• Fever
• Mental status changes such as confusion
• Muscle spasms
• Shivering
• Tremor

Treatment

Serotonin syndrome is treated by stopping any medications you're taking that could be increasing your serotonin levels. Your doctor also may keep you in the hospital for observation for several hours. Serotonin syndrome often resolves within 24 hours of stopping any medication that increases serotonin and starting any necessary treatment.

More severe cases of serotonin syndrome may require additional medications and longer hospitalization. Depending on your symptoms, you may receive the following treatments:

• Monitoring your vital signs, such as heart rate, blood pressure and temperature, and treating those as needed.
• Muscle relaxants. Benzodiazepines, such as diazepam (Valium) or lorazepam (Ativan), can help control agitation, seizure-like movements and muscle stiffness.
• Serotonin-production blocking agents. If other treatments aren't working, the drug cyproheptadine can help by blocking serotonin production.
• Drugs that control heart rate and blood pressure. These could include esmolol (Brevibloc) or nitroprusside (Nitropress) to reduce an increased heart rate or high blood pressure, or phenylephrine (Neo-Synephrine) or epinephrine to increase blood pressure that's too low.

If your condition is severe, you may also need a breathing tube and machine and medications that keep your muscles still (paralyze them).

Prevention

If you're taking serotonin-related drugs, particularly more than one, such as a triptan, with either an SSRI or SNRI, you may be at increased risk of serotonin syndrome. Talk to your doctor about possible risks. Don't stop taking any such medications on your own. If your doctor prescribes a new medication, make sure he or she knows about all the other medications you're taking — especially if you receive prescriptions from more than one doctor.

If you and your doctor decide the benefits of combining certain serotonin-level-affecting drugs outweigh the risks, be alert to the possibility of serotonin syndrome. If you develop restlessness, hallucinations or any other signs or symptoms of serotonin syndrome, seek medical attention immediately.

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By Mayo Clinic Staff
Jun 22, 2007