Aa
can anyone give me info on vomiting after tips
Hi can anyone in here help me out,,my husband had the emerg tips may the 13th,, he came home june 2nd lost 12 lbs with the water pills I guess,,Now for the last 3 days he cant hold down any food vomits at least 2 times a day no blood just food,,,I took him to the emerg last night they said they didnt know why hes vomiting,,,Hes on 30ml of lactalose a day and hasnt had a bowel movement in 2 days,,Im at my wits end I just dont know what to do,,the doctor said he cant take graval so what do i do,,Hes on spirolactone 100 mg,,furosemide 20mg..lansoprazole 30mg 2x a day,,plus insulin,,this is insane I hate watching him vomit seady,,any imput would really help me out ,,getting desperate thanks linda
I agree with Hector, he needs to be seen at the hospital.
You are his advocate, you are going to have to get
demanding in a professional way, he should be seen,
something is not right.
I was told a person with cirrhosis or end stage should be
having 3-4 bowel movements a day. This is so important.
Just a thought, if he can't hold down solid foods ,try boost
or something of that nature.
I would seriously think about getting him back to urgent care.
My heart is with you both.
Elaine
You are his advocate, you are going to have to get
demanding in a professional way, he should be seen,
something is not right.
I was told a person with cirrhosis or end stage should be
having 3-4 bowel movements a day. This is so important.
Just a thought, if he can't hold down solid foods ,try boost
or something of that nature.
I would seriously think about getting him back to urgent care.
My heart is with you both.
Elaine
Hi Linda I can only venture a guess but here are my thoughts...
I must admit I don't know why your husband is vomiting. That worries me. Does he have a fever or other symptoms? A fever might indicate an infection.
"I took him to the emerg last night they said they didnt know why hes vomiting." No bleep! That is why you brought him there... so THEY could figure it out. I thought that was what Emergency Room healthcare was about! That is there job, right? To diagnose and if needed treat the patient. Grrrr. This make me angry.
First, based on my own experience I would say that it appears that your husband is not taking enough lactulose. (See normal dosage below). The amount of lactulose needed varies based on the size and content of the food he was ingesting. Not having a bowel movement for someone with hepatic encephalopathy is serious. It can cause an episode. Was your husband having 2-4 bowel movements before this? Unless he has a blockage of his intestines, he should be able to increase his dosage until he has a bowel movement even though it will probably be diarrhea. He needs to clean the toxins that build up because of constipation. Maybe try a lactulose enema? I haven't done this myself as I just increase the amount of oral lactulose until I get "the runs" if needed.
Make sure your husband remain hydrated. As it will help defecation and prevent onsite of HE.
http://www.rxlist.com/lactulose_solution-drug.htm
Oral
Adult: The usual adult, oral dosage is 2 to 3 tablespoonfuls (30 to 45 mL, containing 20 g to 30 g of lactulose) three or four times daily. The dosage may be adjusted every day or two to produce 2 or 3 soft stools daily.
Hourly doses of 30 to 45 mL of lactulose solution may be used to induce the rapid laxation indicated in the initial phase of the therapy of portal-systemic encephalopathy. When the laxative effect has been achieved, the dose of lactulose may then be reduced to the recommended daily dose. Improvement in the patient's condition may occur within 24 hours but may not begin before 48 hours or even later.
Continuous long-term therapy is indicated to lessen the severity and prevent the recurrence of portal-systemic encephalopathy. The dose of lactulose for this purpose is the same as the recommended daily dose.
"TIPS Procedure Complications
There are a few possible complications associated with the TIPS procedure. The first and major possible risk involved with this procedure is what is known as hepatic encephalopathy. This is a condition where, toxic products that come from the gastro-intestinal tract, which are otherwise filtered out by the liver start accumulating in the blood. Due to this, they reach the brain and can hinder its normal functioning and in severe cases, may even lead to brain damage. Another complication is the possibility of congestive heart failure, because of the sudden spurt and increase in the amount of blood that is reaching the heart due to the shunt. Thus, heart and blood pressure monitoring is extremely important when doing a TIPS procedure. Other TIPS procedure side effects include slight trauma and damage to adjacent blood vessels, infection, fever, etc.
This was all about the transjugular intrahepatic portosystemic shunt, or TIPS procedure. Although there are a few risks involved with this procedure, it is one of the best non-invasive treatment options for dealing with a severe condition like portal hypertension.
...
Rectal
When the adult patient is in the impending coma or coma stage of portal- systemic encephalopathy and the danger of aspiration exists, or when the necessary endoscopic or intubation procedures physically interfere with the administration of the recommended oral doses, lactulose solution may be given as a retention enema via a rectal balloon catheter. Cleansing enemas containing soap suds or other alkaline agents should not be used.
Three hundred mL of lactulose solution should be mixed with 700 mL of water or physiologic saline and retained for 30 to 60 minutes. Lactulose enema may be repeated every 4 to 6 hours. If this lactulose enema is inadvertently evacuated too promptly, it may be repeated immediately.
The goal of treatment is reversal of the coma stage in order that the patient may be able to take oral medication. Reversal of coma may take place within 2 hours of the first enema in some patients. Lactulose given orally in the recommended doses, should be started before lactulose by enema is stopped entirely."
Spirolactone 100 mg, furosemide 20mg is standard therapy to manage ascites and fluid retention.
Lansoprazole 30mg 2x a day,,plus insulin I am not experienced with so I won't comment.
Isn't there a local gastroenterologist available somewhere? Maybe in ER? This is up their alley (so to speak). I would think a CT scan could be used to see if their is any obstruction. Is there phone support where you can talk to a nurse where he had the TIPS done. Surely they have to be concerned about a patient with advanced liver disease vomiting and with constipation. As I said constipation can cause HE and he recently had a very bad episode of encephalopathy after his TIPS procedure. Something doesn't seem right about them not doing anything knowing the complications of cirrhosis your husband has already experienced.
In summary I would first try contacting support at the hospital it is there job to follow through will patient support for anyone having cirrhosis, TIPS and HE. Don't take no for an answer. Any complications a cirrhotic has could be life threatening. Put the responsibility on them. Get the person's name that you take to and say your are worried about your husband's life. Whatever you have to say. Put the fear of god into them. They need to help and not stick their head in the sand! If you can only go to the local ER have the hospital contact your ER so they are aware of your husband's condition and recent TIPS procedure. So ER doesn't do anything that can harm him because he has cirrhosis.
Best of luck.
Hope something here helped.
Hector
I must admit I don't know why your husband is vomiting. That worries me. Does he have a fever or other symptoms? A fever might indicate an infection.
"I took him to the emerg last night they said they didnt know why hes vomiting." No bleep! That is why you brought him there... so THEY could figure it out. I thought that was what Emergency Room healthcare was about! That is there job, right? To diagnose and if needed treat the patient. Grrrr. This make me angry.
First, based on my own experience I would say that it appears that your husband is not taking enough lactulose. (See normal dosage below). The amount of lactulose needed varies based on the size and content of the food he was ingesting. Not having a bowel movement for someone with hepatic encephalopathy is serious. It can cause an episode. Was your husband having 2-4 bowel movements before this? Unless he has a blockage of his intestines, he should be able to increase his dosage until he has a bowel movement even though it will probably be diarrhea. He needs to clean the toxins that build up because of constipation. Maybe try a lactulose enema? I haven't done this myself as I just increase the amount of oral lactulose until I get "the runs" if needed.
Make sure your husband remain hydrated. As it will help defecation and prevent onsite of HE.
http://www.rxlist.com/lactulose_solution-drug.htm
Oral
Adult: The usual adult, oral dosage is 2 to 3 tablespoonfuls (30 to 45 mL, containing 20 g to 30 g of lactulose) three or four times daily. The dosage may be adjusted every day or two to produce 2 or 3 soft stools daily.
Hourly doses of 30 to 45 mL of lactulose solution may be used to induce the rapid laxation indicated in the initial phase of the therapy of portal-systemic encephalopathy. When the laxative effect has been achieved, the dose of lactulose may then be reduced to the recommended daily dose. Improvement in the patient's condition may occur within 24 hours but may not begin before 48 hours or even later.
Continuous long-term therapy is indicated to lessen the severity and prevent the recurrence of portal-systemic encephalopathy. The dose of lactulose for this purpose is the same as the recommended daily dose.
"TIPS Procedure Complications
There are a few possible complications associated with the TIPS procedure. The first and major possible risk involved with this procedure is what is known as hepatic encephalopathy. This is a condition where, toxic products that come from the gastro-intestinal tract, which are otherwise filtered out by the liver start accumulating in the blood. Due to this, they reach the brain and can hinder its normal functioning and in severe cases, may even lead to brain damage. Another complication is the possibility of congestive heart failure, because of the sudden spurt and increase in the amount of blood that is reaching the heart due to the shunt. Thus, heart and blood pressure monitoring is extremely important when doing a TIPS procedure. Other TIPS procedure side effects include slight trauma and damage to adjacent blood vessels, infection, fever, etc.
This was all about the transjugular intrahepatic portosystemic shunt, or TIPS procedure. Although there are a few risks involved with this procedure, it is one of the best non-invasive treatment options for dealing with a severe condition like portal hypertension.
...
Rectal
When the adult patient is in the impending coma or coma stage of portal- systemic encephalopathy and the danger of aspiration exists, or when the necessary endoscopic or intubation procedures physically interfere with the administration of the recommended oral doses, lactulose solution may be given as a retention enema via a rectal balloon catheter. Cleansing enemas containing soap suds or other alkaline agents should not be used.
Three hundred mL of lactulose solution should be mixed with 700 mL of water or physiologic saline and retained for 30 to 60 minutes. Lactulose enema may be repeated every 4 to 6 hours. If this lactulose enema is inadvertently evacuated too promptly, it may be repeated immediately.
The goal of treatment is reversal of the coma stage in order that the patient may be able to take oral medication. Reversal of coma may take place within 2 hours of the first enema in some patients. Lactulose given orally in the recommended doses, should be started before lactulose by enema is stopped entirely."
Spirolactone 100 mg, furosemide 20mg is standard therapy to manage ascites and fluid retention.
Lansoprazole 30mg 2x a day,,plus insulin I am not experienced with so I won't comment.
Isn't there a local gastroenterologist available somewhere? Maybe in ER? This is up their alley (so to speak). I would think a CT scan could be used to see if their is any obstruction. Is there phone support where you can talk to a nurse where he had the TIPS done. Surely they have to be concerned about a patient with advanced liver disease vomiting and with constipation. As I said constipation can cause HE and he recently had a very bad episode of encephalopathy after his TIPS procedure. Something doesn't seem right about them not doing anything knowing the complications of cirrhosis your husband has already experienced.
In summary I would first try contacting support at the hospital it is there job to follow through will patient support for anyone having cirrhosis, TIPS and HE. Don't take no for an answer. Any complications a cirrhotic has could be life threatening. Put the responsibility on them. Get the person's name that you take to and say your are worried about your husband's life. Whatever you have to say. Put the fear of god into them. They need to help and not stick their head in the sand! If you can only go to the local ER have the hospital contact your ER so they are aware of your husband's condition and recent TIPS procedure. So ER doesn't do anything that can harm him because he has cirrhosis.
Best of luck.
Hope something here helped.
Hector
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