"IV Fluid Overload"

About: The Royal Liverpool University Hospital / Older people's healthcare

(as a relative),

My elderly (94) Mum passed away on 10th March 2009. On the morning of her hospital admission some four weeks earlier, I had washed and dressed her and supervised her descent downstairs. She then used her zimmer to sit in an armchair and as normal she chose to have a bit of a nap whilst I did other things.

After half an hour later I tried to wake her but she was very slow to come round and her speech was mumbled and something was clearly the matter so I called an ambulance. At A+E she was more her usual self though over the previous weeks her appetite was poor and she needed lots of encouragement to drink tea/water.

At A+E Mum's vital signs and ECG readings were fine(Two months earlier her own Doctor had stated that apart from a little murmur her heart, B.P., lungs, kidneys, cholestorol and blood sugar were fine and within normal limits. Mum had been treated for Thrush(down below) and had recently had a suppository for constipation.

The hospital decided her only problem was dehydration and put her on an IV drip, which remained in situ for the next three weeks. She was not catheterised until the last few days. Some days she was left in bed, other days she was sat out. They decided to prescribe anti-depressants as a possible reason for poor appetite. I visited twice a day and mostly managed to get Mum to take two Ensure plus drinks and small amounts of home-made food. She started to communicate more spontaneously and we duetted in singing 'Early One Morning' (a home favourite).

However, I voiced my concerns about swelling in her limbs but a Registered Nurse told me that this was nothing to worry about and was normal for someone whose body had been lacking food and fluid. A few days later I queried a noticeable 'wheeze' but the ward doctor ignored this and was more concerned about how I would manage Mum at home, now that she was not weight-bearing very well, having had no physio. Two days later I insisted she needed to be examined and the same Doctor then said "She's got a bit of a wheeze".

The following day I met with the Consultant and his Registrar and they said the plan was for Mum to come home the next week and that no chest infection had been found. Prior to this I had reported that Mum was severely constipated and insisted that an enema was necessary. Her tummy was also very distended. A micro-enema was administered with little result and a stronger enema was prescribed on 3rd March but this was never administered due to Mum's gradual deterioration.

The next day I was advised that Mum did, after all, have a slight chest infection and she commenced with anti-biotics though the following day these were withdrawn when an infection was not the cause of her poor health but closer examination of a chest X-ray revealed "sticky-blood" around the heart.

That weekend a Staff Nurse admitted to me that Mum's condition was due to fluid overload, apparently she had developed Pulmonary Oedema and suffered a "cardiac event" overnight. When I broached this with the Consultant he changed the subject and was more concerned that I accept his colleague's decision to flag-up as Do Not Resuscitate. I was devastated.

On Mum's final day, it was obvious she was in extreme pain and I insisted she be given some pain relief. The Doctor asked her if she was in pain but stoically she said "No" and chose not to prescribe anything. But I had seen her wince and cry out in pain and it wasn't until five hours later that a Nurse actually heard Mum cry out that this Nurse managed to persuade the Doctor to give Mum some Oromorphine. A few hours later Mum passed away following a final stronger dose of morphine. Cause of Death is shown as cardiac failure and myocardial infarction.

Sorry, this has been so long-winded but I need to know if fluid overload is a common occurrence and is it irreversible? What sort of questions I need to be asking when I seek answers from the hospital authorities? Any advice or help you think might be relevant? Thank you for reading.

Ken

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