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 I believe Robitussin DM landed my dad in the hosptial 
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Joined: Sat Mar 27, 2010 6:15 am
Posts: 44
Location: USA
Post I believe Robitussin DM landed my dad in the hosptial
As I have learned more by using the Internet and this website.
I decided to go to the nursing home and get all of my dads medication records, nurses notes, and doctor notes to see if they did anything different leading up to his decline and hospital stay in Feb 2009.

In reading the 4 months prior he is doing great (other than not wanting to live there) he is walking, using the bathroom fine, they have to keep getting after him for walking to lunch and dinner without his walker (because he didn't need it), he is transporting himself in and out of bed okay etc....

They started giving him Robutissin DM on Feb 7th.

Then Feb 10-12 they start sending him to the hospital for breathing problems, hallucinations, fatique, lack of response, talking about stuff that isn't happening, the 11th he stumbles and falls, etc... he makes 3 trips to the hospital but they decline each time to admit him since he seems to not have anything wrong (the E.R. doesn't know him and doesn't know his behavior is not like him) No one from the nursing home goes with him....

I visit him and tell the nursing home they MUST be messing up his medications, or he has had a stroke of SOMETHING. " No no no nothing has changed his meds are the same."

weve always known dad had exaggerated response to any tpe of cold, anti-histamine, allergy type medications,, he just cannot take them. We always thought because of his diabetes but....

I am reading all this stuff and I can see what has happened with each incident and I can see it all started on February 7th with that Robu DM and then the trip to the hospital - where who knows what they gave him.

After 3 days there he went completely out of his head. completely
gone and really, really bad scary scenes. then to mumbling.

Then he miraculously recovered (mostly) after the said they could do nothing for him, could find no infection, no cold, no pneumonia, there was nothing wrong with him..... Since then he has gone downhill ..with corresponding medications to treat increasing confusion, etc...

Is it really possible for someone to have this drastic a reaction to medication? Would it all have happened anyway eventually?


Tue Apr 06, 2010 1:46 am
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Location: Acton, MA
Post 
Grace, Others who know more will also reply, but in our case Benadryl was a nightmare for Frank. He was taking it for poison ivy. He was completely out of it, trying to leave the house in the middle of the night in just underware. My daughter came out and helped me get him to the ER. We also found he could not take Ativan and at one of his stays at the hosiptal, no one looked at the wristband that said NO Ativan, and they gave it to him. There have been 3 times, over the last 4 years that they said he'd never come home and I needed to place him. His last stay, I was very verbal about his meds and gave anyone who entered his room a list of the meds he should NOT have. But he straighten out enough to come home each time. I believe it's the meds. Good luck, it sounds like your doing a great job, with an impossible situation.

Take Care, Gerry


Tue Apr 06, 2010 7:34 am
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Joined: Wed Dec 30, 2009 1:46 pm
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Location: WA
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Yes, it's possible and probable. We learned the hard way that LBD is incompatible with a lot of meds, even OTC.


Tue Apr 06, 2010 9:14 am
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
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I encourage you to ask an MD or pharmacist about this.

My layperson opinion is that it is highly unlikely cough syrup with DM and guaifenesin caused this problem...unless your father is taking an MAO inhibitor or unless the dose was unusually high. (Selegiline and Azilect are MAO inhibitors. Some antidepressants are MAO inhibitors.) A pharmacist should be able to review the medications.

But I don't see that it would change things much if you indicate that your father is allergic or sensitive to dextromethorphan and guaifenesin. This will limit the choices if he does get another cough or cold but you can face that battle when you come to it.

All of the symptoms you mention -- hallucinations, fatigue, lack of response, falling -- are part of LBD.


Tue Apr 06, 2010 10:50 am
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Joined: Fri Jan 15, 2010 9:33 pm
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Location: Vermont
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This is making me wonder about my dad's big decline last year. He started having seasonal allergies about 10 years ago and has taken allergy meds for that for years. I wonder if he took Robitussin or something (and overdosed) last summer and that's what triggered the huge decline....... Interesting.


Tue Apr 06, 2010 9:41 pm
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Joined: Sat Mar 27, 2010 6:15 am
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Robin,
Are you saying you do not believe OTC allergy, cold & sinus, etc... can cause the toxic reaction (and possible decline) that 50% of LBD people are suppose to have a strong neuroleptic sensitivity to? or are you thinking this only refers to some anti-psych meds?
My dad certainly always reacts adversely to any type of allery, cold & sinus, mri dye, haldol, etc...

I think this is part of the reason many senior have "hospital delirium". They have a severe reaction to something the hospital gave them.

At the hospital I would tell them "my dad is not like this, something is really wrong" and they would say - yeah we see this often with elderly, one person told me that anti-biotics can sometimes make the seniors act out of their heads?
I also found out they were giving my dad Tylenol PM (to help him sleep)
well that would affect him adversely too. When I said NO you cannot give him tylenol PM are you sure it was PM and she said Yes. I said his chart should show he cannot take anything like that.
Then she went and talked to another girl and came back and said "oh no we only gave him tylenol" - I said "why would you give him tylenol?" was he complaining of pain.
She just didn't say anything.

Man it is really hard to be there every minute and to really find out what is going on if you are not taking care of a person in your home.
It just seems hopeless at times. .


Wed Apr 07, 2010 10:41 am
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Not just the elderly. When one of my grandsons was little, he went bananas on dextromethorphan. I think they finally took it out of children's cold medicine.


Wed Apr 07, 2010 11:28 am
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Joined: Sun Oct 04, 2009 10:18 am
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Location: Washington State
Post Managing Care - My Experience
Grace, my LO lives in an ALF. She goes to the hospital occasionally when she falls and they have to check her out because the medtechs think she may have a fracture. When she goes to the hospital we have a family member with her at all times. Even overnight. We take shifts of a couple of hours then someone else comes on. It helps to keep her calm and in the hospital bed. If the Dr. or nurse wants to give a medication I am usually there. If I'm not, the family member on shift will call me because I'm the only one that has her complete medical history and research. I keep a copy of the Boeve continuum in a notebook with me. If I weren't there could I prevent them giving her a medication? Probably not. But I've had my sister put me on the phone to talk to the nurse and explain why a medication shouldn't be used. It has worked so far.

Yes, it is hard to manage care but I think it would be just as hard if my LO lived in my home. If she goes to the hospital that just takes priority over every time committment in my life.

On the positive side, we haven't been to the hospital since Feb. 20th. Woo hoo!


Wed Apr 07, 2010 11:31 am
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
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"Neuroleptic sensitivity" refers to anti-psychotics (also called neuroleptics). An example of this you mentioned is Haldol.

I think the primary cause of hospital-induced delirium is simply being in the hospital, which is an extremely stressful environment, and having few reserves to handle the stress.

My guess is that if you dad was given Tylenol PM at the same time he was given a guaifenesin/DM cough syrup, it's more likely that the Tylenol PM caused the reaction and landed him in the hospital. Tylenol PM is a no-no for LBDers because it's anticholinergic.

Perhaps you need to have a care conference with the lead RN at the facility?


Wed Apr 07, 2010 12:28 pm
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A nurse cannot give a medication that wasn't ordered by the physician. Ask to see the medication orders in the chart [the 'med sheet']. Sometimes doctors leave 'standing orders' which nurses can give without a specific order. These usually include milk of magnesia, acetaminophen, etc. However, these should also appear on the med sheet. If you have medical POA, you will be allowed to see it. If there are medications on there that your LO should not take, notify the ordering physician.


Wed Apr 07, 2010 12:40 pm
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Post 
mockturtle,
Would a "standing order" be described as "PRN" (give as needed)?
Robin


Wed Apr 07, 2010 12:56 pm
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No, not really the same thing. PRN just means 'as needed' and could apply to narcotic analgesics as well as 'standing order' drugs such as MOM and Tylenol.


Wed Apr 07, 2010 1:45 pm
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Post Re: I believe Robitussin DM landed my dad in the hosptial
They started giving him Robutissin DM on Feb 7th.

Grace,
I want to address the Robitussin mention here:
Obviously there was a reason they starting giving the Robitussin such as possible infection or some sort of illness, perhaps the combination of the two is what caused the decline and not a neuroleptic sensitivty and as posted earlier it is always best to check with the Doctor or pharmacist in these matters. The cold /allergy issues we had and I mentioned earlier with having an issue was Benedryl and that can cause some problems with a few people but again no fort all ,some can take it with no problem!

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Irene Selak


Thu Apr 08, 2010 11:35 am
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In the corresponding log I read to see why they started giving Rob DM it says because he had a cough. (he is smoking lots of skinny cigars,,, off and on)

He may have had a cold/congestion. They started the Rob DM on the 7th he had a fever & confusion by the 10th. They sent him by ambulance to a local hosp but the ER didn't find anything wrong with him. (no one went with him, the nursing home is not in our city) The hosp sent him back, the 11th he went back to the ER again,,, they said maybe COPD and sent him back with some oxygen, he got up in his confusion and fell down,,, I went down and was surprised he was so confused. I stayed with him for about 4 hours.
He was pretty out of it. I had him call his brother and he had a very off balance conversation with him.
I asked again if they were sure they were not messing up his meds or had not added anything? NO no no They had been giving Robitussin DM and I believe possibly Tylenol PM although they do not indicate that.

He did not seem to have a cold or anything to me just was very confused.
then they sent him a 3rd time to the ER
My older sister went down to the hospital / Dad was left in the ER for hours and hours and hours and got more and more weird. Had an accident and urinated on himself for the first time ever. Which distressed him greatly and led to more confusion and upset.
The hospital finally admitted him.

I now have to get the hospital records to see what they did because he had a few days of off/ on behavior and then on the 3rd day went completely nuts. Delirium very bad for 2 days.
I believe they gave him Haldol and Tylenol PM.
etc.... about the 5th day he was so bad the hospital wanted him GONE. The nurses hated him and this was nothing, nothing like my dad.
They had found no problems so they quit all test and drugs. (they had put him on a catheter for the first time in his life -(which he ripped out)
so there was some damage in that area.

My sister filed a complaint so they decided to send him to rehab which was on another floor. The 7th day he woke up and was doing well. I made them quit forcing him to stay in bed... I made them start helping him to the bathroom rather than forcing him to go in bed.

On the 8th day PT came in and evaluated him... had him walk around, had him do this, do that... The PT guy said "well I expected a real bad time and someone in terrible shape" - you are not the man I read about!
And they accepted him right into their PT program.

He was PT for a week or two and then went back to the nursing home after passing all the PT test - walking a distance without help, climbing some stairs, and other tasks. He became very clear headed.

Then it was so weird,,, when the nursing home took him back they made him stay in a wheelchair and put alarms on everything. Good grief.
It took me a week + to get them to allow him up with his walker and get him into an ongoing PT program.


Thu Apr 08, 2010 1:58 pm
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Joined: Sat Jan 03, 2009 2:59 pm
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Grace,
Aftre reading further the happenings I understand a little better, falls can cause major declines, so that was probably the start of it and then if they in fact gave him haldol which I suspect they did as many hospitals will do that with a confused, agitated or combative patient, thats probably where the problem lies so if he has come back as well as he has then consider yourselves lucky because the often don't !

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Irene Selak


Thu Apr 08, 2010 2:25 pm
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