57 Years Old On Opiates. Started To Urinate All The Place. What To Do And What Is Going On?

Posted on Fri, 10 Aug 2012

Question: May not be able to afford this....my 85 year old private duty patient who has been detoxed from a 30+ year addiction from opiates, has started to urinate on the furniture, on the floor, in her shoes, and also defecates. sssssShe does this when I am not on duty, but I see the results. She has an IQ in excess of 160 and shows no signs of dementia. She has a 57 year old vietnam vet son from whom she has stolen his inheritance and lives with him in lower class housing. Son is immaculate and kind. Mother helped institutionalize her own mother for 40 years to collect a check for disability. What can we do and what is going on. Bladder has been checked and scoped and vaginal exam normal.
she is incredibly sharp and shows no signs of dementia.

Answered by Dr. Ram Choudhary (6 hours later)

Hi XXXXXX,

Welcome to healthcare magic!
Thirty long year on opiates indicates that the patient must be having physical dependence and should have been detoxified over few weeks rather than days and I would advise to decrease the opiate dose first then to supplement methadone for some days then decrease methadone and switch on to long acting benzodiazepine like Lorazepam.
Drug addiction does not means dementia necessarily.
I think the lady is having Withdrawal syndrome with Acute confusional state.
It can be fatal if continued.
So drug her again partially and later taper it. You can use iv morphine, fentanyl at 6 hourly intervals. At present to control the aggression you can use inj. seranace and phenergan as required.
Please get an ECG before you give haloperidol to rule out long QT Syndrome which can lead to Torsade de pointes arrhythmia in some patients, which is a fatal cardiac condition.
Then come to the plan I have already suggested.
She needs a physical examination by the physician and get base line investigations like Chest X XXXXXXX Electrocardiogram, Complete Blood Counts, Renal Function Test, Liver Function Test, Fasting and Post-Prandial Blood Sugar, Thyroid Profile, Lipid Profile, Ultrasound Abdomen, Urine Compete Examination.
This work up is exhaustive but would be helpful in detecting some unsuspected problem if any, if it is causing all the troubles.

I hope this advise would be helpful for you.

Still if you have any queries or doubts, please write me back,
I would be happy to solve them.

Wish you a great health!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ram Choudhary (10 hours later)

Thank you Dr. Choudhary so very much. We will follow your advice.

Answered by Dr. Ram Choudhary (5 hours later)

Hi,
Welcome back to healthcare Magic!
If you need any further advise or clarification let me know.
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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar