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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Was Admitted For Lumbar Back Pain. Given Contin. Had Resp Acidosis & Transferred To CCU. Went Into A-fib. Due To Overdose?

My 69 year old mother who was admitted for lumbar back pain and is very narcotic naive was given 100mg of MS contin twice in 30 hours, became obtunded and had to be transferred to ccu, with resp acidosis renal failure since no iv fluids or po intake was given to her while she was over sedated needed bipap a picc line, a narcan gtt and went into a-fib which she never had untill this episode and placed on a cardizem gtt. now she is awake but has suffered two infarcts in the frontal lobe of her brain per MRI done 6/5/13 could the oversedation have caused this?
Wed, 12 Jun 2013
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General & Family Physician,  's  Response
Hi,
Based on the information here is what I think happened.
1) Due to heavy narcotics for the lumbar back pain it lead to decrease the respiratory rate (leading to acidosis due to co2 excess)
2) No iv fluid did the damage to renal tubules leading to renal failure from drug insult, as well as less fluid supply to flush kidney, and leading to a low PH in blood.
so from (1) and (2) it lead to "Acute acidosis with renal failure"

Now (3) acute acidosis with renal failure - may lead to the "ATRIAL- FIBRILLATION"
Their after (4) A-fib- - created a embolism of blood clot / fatty products mixed with blood, and blocked the artery supplying the frontal lobe leading to
(5) infarct on to frontal part of brain.

Now if we see and consider steps from 1-5 in a sequential order it may give the result describe in the question.

(NOTE :-This is for knowledge only, you must not use my opinion for medico legal issues.)

Hope it helps.
Dr.JAY PATEL.
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Was Admitted For Lumbar Back Pain. Given Contin. Had Resp Acidosis & Transferred To CCU. Went Into A-fib. Due To Overdose?

Hi, Based on the information here is what I think happened. 1) Due to heavy narcotics for the lumbar back pain it lead to decrease the respiratory rate (leading to acidosis due to co2 excess) 2) No iv fluid did the damage to renal tubules leading to renal failure from drug insult, as well as less fluid supply to flush kidney, and leading to a low PH in blood. so from (1) and (2) it lead to Acute acidosis with renal failure Now (3) acute acidosis with renal failure - may lead to the ATRIAL- FIBRILLATION Their after (4) A-fib- - created a embolism of blood clot / fatty products mixed with blood, and blocked the artery supplying the frontal lobe leading to (5) infarct on to frontal part of brain. Now if we see and consider steps from 1-5 in a sequential order it may give the result describe in the question. (NOTE :-This is for knowledge only, you must not use my opinion for medico legal issues.) Hope it helps. Dr.JAY PATEL.