Post CABG low grade fever with pleural effusion

[amit_srivastava]

Hi,
My father underwent CABGx3 some 4 weeks ago. Since last 3 weeks he has developed low grade fever where his temperature hovers between 99 to 100 celcius along with little cough. Other than the aforementioned he looks to be doing pretty fine.
His fever responds well to NSAIDs, more to diclofenac sodium as compared to paracetamol.
Plueral Effusion was recently diagnosed on the left side and approximately 800 ml was drained through ICD implant last weekend; however the same type of fever is still persisting.
The drain was blood mixed and doctors called it to be reactionary fluid. Even though I asked them many a times to send the drain for culture and microscopic examination, they did not do so. More so the doctors havn't given him any diuretic, nor any corticosteroids.
Please help me by letting me know within how many days or months will he be completely fine to join his office?
Thanks for all you help....
Regards,
Amit

[amit_srivastava]

Hi Ken,

Thanks for the response......

I agree to most of your points except for infection. My father has undergone almost all the tests related to pleural infection and his reports are completely normal. I think his fever is solely due to fluid accumulation. Is this possible? Please correct me if you feel otherwise. He is currently on Amoxy-Clav and Levofloxacin along with Metformin and Beta-blockers. Are these going to help?

As cIeary stated by you, I agree that the reason for pleural effusion, might be heart related i.e. his heart is not strong enough to pump a normal amount of blood into circulation received from the lungs. His ejection faction was 55% prior to surgery and it hasn't been checked after surgery. Should I go for the EF examination one more? Is it okay to give diuretics and corticosteroids so early after surgery.

Thanks for all your help...
Regards,
Amit

[kenkeith]

There appears to be an infection as evidenced by the fever, and there is a respiratory disorder.  Plueral effusion is excessive fluids in the lungs.  That can be heart related; if the heart is not strong enough to pump a normal amount of blood into circulation received from the lungs, the blood backs up in the lungs and fluids leak into the tissue.

If there is inflammation cortidcosterois would be appropriate.  A diuretic would be helpful to help rid the system of fluids, and it seems an antibiotic would also be a consideration.  I can't comment on your doctor's decisions, but your opinion for treatment doesn't seem unreasonable.  How many days or months for better health can't be said...it depends on how effective the medication and the underlying cause.