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Suggest Treatment For Excessive Salivation In An Elderly Person With UTI

Posted on Fri, 23 Oct 2015

Question: My 92 year old mother is in hospital with a urinary infection which she is now recovering however during that time she has been bringing up saliva whenever she tries to eat or drink so has stopped has t eaten now for 2 weeks doc 1st said it was a hernia now changed their mind and want to do further tests what is it

Answered by Dr. Rakesh Madhyastha (16 hours later)

Brief Answer:
Need more info

Detailed Answer:
Hello

Thanks for the query

I understand that your mother has been treated successfully for urinary tract infection. She is now having difficulty in eating where there is excessive salivation. In order to help you better I need a few more details from you

1. Does she have trouble swallowing as well?
2. Is she drinking liquids ?
3. How is her mental status ? is she alert and active ?
4. Hernia can occur in various parts of the body, where does the doctor think the hernia is? Did the doctor tell how it is related to salivation ?
5. does she have fever now ?

Please get back to me , I am awaiting your reply

Regards

Above answer was peer-reviewed by : Dr. Sonia Raina

Follow up: Dr. Rakesh Madhyastha (11 days later)

I only just received review which flagged up the reply never came to my Inbox.

However in response to your questions:-

yes

sometimes v good and alert sometimes not

Upper abdomen but now not sure she has one and she is currently undergoing endoscopy

no fever

I await your advice

Answered by Dr. Rakesh Madhyastha (3 hours later)

Brief Answer:
further work up required

Detailed Answer:
Hello

Thanks for getting back with all the details. Here is what you should do

1. If she is able to swallow liquids but not solids then it is most likely that she is suffering from esophagitis. Candidal infection usually present this way. What did the endoscopy show

2. Urinary tract infection does not lead to salivation however it does lead to loss of appetite. Get a urine routine done nonetheless

3. Waxing and waning of mental status should be evaluated for. The most common in this age group is electrolyte imbalance. Please get serum electrolytes

Any hernia is not a medical emergency unless it is causing severe pain

I hope I was of help, if you have any further queries please get back to me

Regards

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Rakesh Madhyastha (1 hour later)

She cant swallow liquids v well lucky if she has 10/15 sips a day and one biscuit

Been in hospital 3 weeks 5 days not eating or drinking has potassium and glucose IVs

They hv taken biopsy I'm waiting to hear they say it may be 5 days

Answered by Dr. Rakesh Madhyastha (17 hours later)

Brief Answer:
Dysphagia

Detailed Answer:
Hello

Thanks for getting back with the details, I am sorry for the short delay in my reply.

Low potassium can lead to reduced mental status however it does not explain why she is not able to swallow.

What did the endocopy report show? Usually patients with fungal esophagitis behave this way. We often see low potassium in fungal infections.

Please let me know these two reports and also enquire about the working diagnosis with the doctors.

Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Rakesh Madhyastha (5 hours later)

Thkx for reply
Mum is having potassium I V
Endoscopy showed narrowing if oesophagus at bottom took biopsy awaiting results suggesting acid reflux or
Cancer
If acid reflux said can treat it if cancer maybe put in stent if gastro specialist thinks it can be done

Answered by Dr. Rakesh Madhyastha (9 hours later)

Brief Answer:
stricture

Detailed Answer:
Hello

Thanks for getting back with the details, stricture of the esophagus must be causing all the problems. I recommend prokinetics like domperidone or mosapride twice a day for better appetite however a better solution would be balloon dilatation of the stricture after the biopsy report

Regards

Above answer was peer-reviewed by : Dr. Neel Kudchadkar

Follow up: Dr. Rakesh Madhyastha (6 days later)

thank u for your recent reply.

My mother had a second endoscopy yesterday by the XXXXXXX gastroentrologist.

He concluded there was no narrowing of the oesophagus and no problems whatsoever except inflammation caused by acid reflux. Apolyp was found but although sent for biopsy said this is not a problem.

he recommended continual treatment with anti acid medication, she should be able to eat and drink now without any problems to build up her strength after 5 weeks in hospital and her mental condition monitored for her future welfare.

My question is this the XXXXXXX gastroenterologist told me the person who carried out the endoscopy last week got it wrong. so my mother has suffered for a further week because an inexperienced person dealt with the procedure. The hospital took over a month to identify this problem and it was with me continually requesting consultations with the consultant that led to further investigations for my mum but until I pointed out she wasn't eating or drinking they hadna't recorded the probelm and were only treating her for a urinary virus. What is my position on her treatment?

Answered by Dr. Rakesh Madhyastha (15 hours later)

Brief Answer:
Gastritis

Detailed Answer:
Hello

Thanks for getting back. I am delighted by the way you are taking care of your mother, such people are hard to find. I am very happy that there is no narrowing of the lumen, narrowing of the lumen is difficult to treat especially in elderly

Here is what you should do

1. Feed her in upright position, let her not lie down and eat. Make sure she is upright for a while after eating
2. avoid milk, milk products and caffeine. Let the food contain lots of fruits and vegetables
3. continue the medications given to her, also please attach the discharge summary so that I can go through the course of the hospital, diagnosis and treatment given

Regards

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Rakesh Madhyastha (13 hours later)

hello

thank you for your reply and information

I will send the discharge ino when she leaves which won't be for at least a week as build up of strength is now essential

Please keep it open until then.

kind regards

Eona

Answered by Dr. Rakesh Madhyastha (15 hours later)

Brief Answer:
Follow up

Detailed Answer:
Hello

Thanks for getting back, if discharge is late then you could request for a course in the hospital by the doctor. That can give me a good picture

Regards

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Above answer was peer-reviewed by : Dr. Sonia Raina