Dehydration and heart rate question

Hjlee

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Hi all, its been long time that i posted in here. (i think last question i asked here was about trach. )
Thanks to you guys, we could prepare everything and learned what we need to know about the trach.
For better understanding i want to update my mom's status first.
She got the g-tube when she did the trach surgery (Oct, 2018) and shes doing all fine until these days.
She got gallbladder tube because of stone since doctor did not recommend surgery for removing it.
Recently, she started to have infection here and there.
First she went to ER for skin infection around the gallbladder tube (we change dressing everyday) with dehydration.
Second she went to ER for UTI with dehydration. Third, she went to ER for dehydration.
She is on two antibiotic for skin infection and UTI now.
We give her at least 2L liquid (including her formula) and it seems like it is not enough.
Doctor told us to increase 2.5L but still it seems not enough for her when i see her heart rate. (it goes above 120)
when her heart rate goes above 120, we usually give her ativan and works if it was for panic attack. it doesnt work if its not a panic attack.

So my question is how do you guys manage the dehydration?
Also, her heart rate is stable when she is in bed but goes up above 130 when she sits in wheelchair. Any advise?

Thank you and i will look forward to hearing from you guys
 

KarenNWendyn

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I think her situation is more complicated than what we can advise you here. When people have infections, it can throw off their fluid balance. Generally they need more water, especially if there is a fever. The problem is that when someone is more ill such as your mom due to dependency on the trach and also needing the gallbladder procedure, her fluid and electrolyte balance could be way off. There may even be some cardiac issues we don’t know about. The elevated heart rate could be from a systemic infection, dehydration (due to infections), or an underlying cardiac problems. The problem is that one can also give too much water. Sometimes there’s a fine balance.

I think your question is a good one, but I believe this should be managed under a physician’s guidance. Someone with a very labile blood pressure and heart rate may even need to be managed in a hospital setting. So I would suggest you start by contacting your physician. Hope this makes sense.
 

KateEmerson

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My husband also had a gtube and trach with multiple other conditions....kidney disease, labile blood pressure, heart problems, and others. It is definitely difficult to figure out what is the source of the problem. I agree with Karen that a doctor needs to be involved and overseeing her health. We were very fortunate to have an internist that we worked very closely with. I find it interesting that the high heart rate only occurs when in the wheelchair, I think this is very important to communicate. Is it possible that her vent settings need to be reviewed? My husband had two settings, one for daytime and one for nighttime when he was in bed. Do you have an oximeter and blood pressure cuff? I think it would be helpful to measure her O2 and BP when she has the rapid heart rate episodes and give all three to the Dr. Just a little factoid I learned, enteral feeds vary as to the % of fluid , ours ranged from 60% to 80%. Hope you can figure out her heart rate and hydration issues, Kate
 

lgelb

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Hi, HJ,

I'm sorry about your mom. Did she have an EKG during any of her ER visits?

Antibiotics themselves, as well as UTIs, increase the need for water, but also nutrition. If her pulse goes up in the wheelchair, I would wonder if her BP is dropping so certainly agree with BP and O2 as Kate suggests.

If hydration improves, the balance of nutrients could be more the problem, or a secondary infection. Is there fever now? As Karen said, it is complex and a good internist can be really important, now and in the future.

If she is on a commercial formula, I would consider a less processed formula like Kate Farms or Liquid Hope. I hope she stabilizes soon.

Best,
Laurie
 

Hjlee

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Hello Karen, Kate, and Laurie
Thank you for the reply. We have Oximeter to see her O2 and heart rate. Her O2 is above 97 and her BP is also normal. She done several EKG and heart test (CT, xray) and came out normal. If mom has cardiac issue, we cant find out from CT or xray? We see my mom's primary doctor once in two month or after the ER visit for follow up. Her heart rate is 90-110 when she sleeps, 100-120 when she wake up (even in bed) and goes above 130-150 when she sits in wheelchair but she doesnt complain any hardship compare her heart rate being above 120 when she gets infection. Doctor said that she is not worried about her heart rate being fast if she is comfortable with it. Weird thing is that she never had a fever when she got the infection or with high heart rate. (avg is 97)
Emergency room doctors and her primary doctor is not worrying about the cardiac issue but i am just worried about her dehydration due to her rapid heart rate.
 

KarenNWendyn

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I recommend calling the primary doctor and relaying the information about the heart rate. Then ask how much water to give.
 
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