Case study, alt med for respiratory distress in the acute inpatient setting
For your consideration.
A recent 7-day admission at an acute care hospital for a 8-year-old boy with difficulty breathing. On admission, his room air blood oxygen saturation is 85%, and no peak flow can be measured despite 2 days of oral prednisone and multiple back-to-back albuterol and Atrovent treatments.
Day 1: Difficulty breathing, with cough especially when he ambulates. Nebulized albuterol at least every 2 hours provides no relief. Respiratory rate around 30. Oxygen via nasal cannula averages 3 liters per minute to keep saturation above 90% Chest x-ray shows reactive airway disease with a possible perihilar mass.
Day 2: Condition not improved. Oxygen needs occasionally reach 8 liters per minute. CAT scan is done and doesn't identify a perihilar mass, but does see a hypodensity around the liver. Liver function tests are ordered.
Day 3: Slight improvement in symptoms with less difficulty breathing. Still requires up to 5 liters per minute oxygen. Decreased cough, but increased nasal congestion is noted. Liver tests are all essentially normal. Pulmonary consult is performed and a series of antibody tests are ordered.
Day 4: Symptomatic especially with exertion, still requires 2-5 liter per minute oxygen by mask due to nasal congestion. Parents (who are constantly at the bedside) request that they administer "homeopathic drops", which is granted. IgE antibody result is 602, significant for severe allergies. Allergy/immunology studies ordered.
Day 5: Still requires around 3 liters per minute oxygen. Lung sounds are noted as not nearly as "noisy." Parents request that the family's chiropractor come in to do an "adjustment" and also perform acupuncture. Hospital and physician agree that nothing prevents the chiropractor from coming in as a visitor (as he has no practice privileges at the hospital.) Meanwhile, 5-day course of Zithromax is completed and the medical specialists contemplate an etiology and careplan based on the "one airway" theory. Allergy and upper airway medications are added to the treatment regimen.
Day 6: Oxygen is weaned throughout the day with intermittent episodes of room air. EKG shows axis deviation and an echocardiogram is ordered, which rules-out significant cardiac abnormalities. Discharge planning is initiated for the next morning.
Day 7 Discharged to home without supplemental oxygen and on a combination of allergy and asthma medications. Parents request that a "natural" brand of Iron supplement be used instead of the one available at pharmacies.
Complimentary Medicine Summary: This boy did not show much improvement in symptoms despite all the treatment and medications given for more than two days in the hospital. But he shows some, almost immediate improvement soon after homeopathic drops are administered. And he no longer needs supplemental oxygen one day after his chiropractic adjustment and acupuncture treatment.
Case conclusion/comments: The patient likely experienced an upper airway viral infection or other antigen that exacerbated his known asthma and as yet unidentified allergies. Through natural course, standard medical treatment, and the addition of allergy medication and treatment, the patients symptoms subside on the sixth day of admission. The homeopathic and alternative treatments concurrently administered are likely inconsequential to clinical outcomes. Standards of medical practice dictate that even though the CAT scan, echocardiogram, and liver functions tests are normal, they are essential in this case, especially in the presence of an unclear etiology causing a persistent hypoxemia. Finally, caution should be used in prescribing so-called "natural" iron supplements due to no manufacturing oversite or guarantee of potency or purity.
A recent 7-day admission at an acute care hospital for a 8-year-old boy with difficulty breathing. On admission, his room air blood oxygen saturation is 85%, and no peak flow can be measured despite 2 days of oral prednisone and multiple back-to-back albuterol and Atrovent treatments.
Day 1: Difficulty breathing, with cough especially when he ambulates. Nebulized albuterol at least every 2 hours provides no relief. Respiratory rate around 30. Oxygen via nasal cannula averages 3 liters per minute to keep saturation above 90% Chest x-ray shows reactive airway disease with a possible perihilar mass.
Day 2: Condition not improved. Oxygen needs occasionally reach 8 liters per minute. CAT scan is done and doesn't identify a perihilar mass, but does see a hypodensity around the liver. Liver function tests are ordered.
Day 3: Slight improvement in symptoms with less difficulty breathing. Still requires up to 5 liters per minute oxygen. Decreased cough, but increased nasal congestion is noted. Liver tests are all essentially normal. Pulmonary consult is performed and a series of antibody tests are ordered.
Day 4: Symptomatic especially with exertion, still requires 2-5 liter per minute oxygen by mask due to nasal congestion. Parents (who are constantly at the bedside) request that they administer "homeopathic drops", which is granted. IgE antibody result is 602, significant for severe allergies. Allergy/immunology studies ordered.
Day 5: Still requires around 3 liters per minute oxygen. Lung sounds are noted as not nearly as "noisy." Parents request that the family's chiropractor come in to do an "adjustment" and also perform acupuncture. Hospital and physician agree that nothing prevents the chiropractor from coming in as a visitor (as he has no practice privileges at the hospital.) Meanwhile, 5-day course of Zithromax is completed and the medical specialists contemplate an etiology and careplan based on the "one airway" theory. Allergy and upper airway medications are added to the treatment regimen.
Day 6: Oxygen is weaned throughout the day with intermittent episodes of room air. EKG shows axis deviation and an echocardiogram is ordered, which rules-out significant cardiac abnormalities. Discharge planning is initiated for the next morning.
Day 7 Discharged to home without supplemental oxygen and on a combination of allergy and asthma medications. Parents request that a "natural" brand of Iron supplement be used instead of the one available at pharmacies.
Complimentary Medicine Summary: This boy did not show much improvement in symptoms despite all the treatment and medications given for more than two days in the hospital. But he shows some, almost immediate improvement soon after homeopathic drops are administered. And he no longer needs supplemental oxygen one day after his chiropractic adjustment and acupuncture treatment.
Case conclusion/comments: The patient likely experienced an upper airway viral infection or other antigen that exacerbated his known asthma and as yet unidentified allergies. Through natural course, standard medical treatment, and the addition of allergy medication and treatment, the patients symptoms subside on the sixth day of admission. The homeopathic and alternative treatments concurrently administered are likely inconsequential to clinical outcomes. Standards of medical practice dictate that even though the CAT scan, echocardiogram, and liver functions tests are normal, they are essential in this case, especially in the presence of an unclear etiology causing a persistent hypoxemia. Finally, caution should be used in prescribing so-called "natural" iron supplements due to no manufacturing oversite or guarantee of potency or purity.
posted by nawledge at
9:46 PM
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