October 23, 2017 at 11:02 am #1376Archived PostsModerator
Does anyone have any experience of supporting a patient with delirium? Apparently it can take months to fully recover, and I’d like to try to support recovery. Currently doing Hulda Clarke’s kidney flush and maintaining hydration; starting ketogenic diet.
The infection began on 19th September; he was in hospital from 20-25 September (oral and IV antibiotics).
Chest x-ray, CT head, MRI head, u/s carotid, u/s BPK show nothing of particular concern; ECG has shown minor irregularities and an echocardiogram plus 24hr heart trace are both planned.
Confusingly, the medical consultant who saw this patient on the Medical Ward has diagnosed TIA; the neurology consultant he saw later is adamant he has not, and that he has had a kidney infection followed by delirium, and a vasovagal episode (fainting) on 2nd October.
I’d appreciate your thoughts, please.
Posted By Sheila Shepherd 23/10/17
March 21, 2019 at 11:21 am #1377Christine BaileyModerator
Many thanks for your question regarding your client with suspected kidney infection and delirium. The NICE guidelines highlight various risk factors associated with delirium together with signs and symptoms and recommendations for action which you may wish to read: http://tinyurl.com/ybwk8rgt.
As part of these recommendations they highlight the importance of looking for underlying triggers which could include infections, dehydration, kidney infections, heart issues, etc.
Delirium is a common condition that usually affects patients’ brains for a very short period of time. In 6 out of 10 patients the symptoms generally disappear within six days and other
patients may continue to experience one or more symptoms when leaving hospital. A small
number of patients (around 5 per cent) may still suffer from delirium more than a month after they first experienced the symptoms.
Delirium can cause:
complete change in personality
physical change in the patient’s condition, such as difficulty walking, swallowing or
Patients with delirium may not recognise even their closest family. They may become paranoid, developing an extreme and irrational fear or distrust of others, and it is common for patients to have hallucinations (seeing or hearing things that are not there).
More than half of patients admitted to hospital become delirious at some time during their stay. Delirium often has many causes, which can make it difficult to recognise and treat. The age of the patient, especially if they are over 80 years old, and if they have already been diagnosed as having some form of dementia are the biggest risk factors for delirium. But it can occur in younger patients as well. It is a condition which can be distressing and frightening for patients and for their friends and relatives. Patients may not remember much of the illness when they are better, and this in itself can be cause for distress.
There are many triggers for this condition and kidney infections are particularly linked. Glomerulonephritis is inflammation of the kidneys that can lead to kidney failure.
Chronic kidney disease is a progressive and irreversible destruction of the kidneys. High blood pressure and diabetes can lead to this condition so you may wish to check blood pressure and glucose levels and keep this balanced. UTIs commonly involve the bladder and kidneys and are caused by bacteria traveling up the urethra. They’re much more common in women, as their anatomy has shorter urethras and therefore a shorter route for the germs to travel. These can also be linked to delirium.
Clearly it is not our role to diagnose conditions but in view of the health history the kidney infection may be the key contributing link here. Checking overall kidney function (i.e. GFR) would be important as well as electrolyte balance. The presence of elevated amounts of protein in the urine (proteinuria; > 150 mg/day) represents a loss in the ability of the glomeruli in the kidney to selectively retain blood proteins, which ultimately leads to difficulties maintaining blood volume and is a powerful predictor of kidney failure.
Due to the tremendous blood flow and high concentration of metabolic toxins continuously circulating through the kidneys, the kidneys are the site of extraordinary oxidative stress, which is known to contribute to progressive kidney damage and its complications (i.e., high LDL and increased cardiovascular disease risk).
Gazdikova K, Gvozdjakova A, Kucharska J, Spustova V, Braunova Z, Dzurik R. Effect of coenzyme Q10 in patients with kidney diseases. CasLekCesk. 2001 May 24;140(10):307-10. http://tinyurl.com/yb99lytv
Coenzyme Q10 (CoQ10) fortifies the body’s natural antioxidant capacity and reduces levels of oxygen free radicals, which may be helpful.
Animal studies have also shown that CoQ10 can protect kidney tissue from numerous nephrotoxic drugs, including gentamicin, a powerful antibiotic with a notorious propensity for causing kidney damage.
Farswan M, RathodSP, Upaganlawar AB, Semwal A. Protective effect of coenzyme Q10 in simvastatin and gemfibrozil induced rhabdomyolysis in rats. Indian J Exp Biol. 2005 Oct 2005;43(10):845-8. http://tinyurl.com/yauera2z
Silymarin is extracted from milk thistle (Silybum marianum), a plant rich in the following flavonolignans (natural phenols composed of flavonoid and lignin): silychristin, silydianin, silybin A, silybin B, isosilybin A and isosilybin B — collectively known as the silymarin complex. This safe, natural compound has a long history as a traditional therapy for liver and kidney conditions.
As your client has been given IV antibiotics it would be appropriate to replenish the gut flora in addition to supporting overall kidney health.
One of the kidneys’ chief roles is excreting excess acid to keep the pH of blood in the narrow, slightly alkaline range necessary to support normal metabolic function. Because most typical diets produce a slightly net acid excess, the kidney must continuously excrete this acid residue. As kidneys age and gradually lose some of their functional capacity, they become less efficient at eliminating this acid so more of it remains in the bloodstream.
Correcting low-grade systemic metabolic acidosis with alkali salts, such as sodium bicarbonate or potassium citrate, corrects some of these biochemical consequences.
A diet higher in alkaline elements from fruits and vegetables also neutralizes this acidic condition, making it a potential therapeutic strategy – so include green superfood powders as well as plenty of colourful vegetables.
Starke A, Corsenca A, Kohler T, Knubben J, Kraenzlin M, Uebelhart D, . . . Ambuhl PM. Correction of metabolic acidosis with potassium citrate in renal transplant patients and its effect on bone quality. Clinical journal of the American Society of Nephrology : CJASN. Sep 2012;7(9):1461-1472. http://tinyurl.com/y98n9ocq
The bacterial microbiome within the human gastrointestinal tract has important implications for kidney health. When the intestinal microbiome is perturbed, a phenomenon known as dysbiosis, uremic toxins such as p-cresyl sulfate can accumulate and promote CKD progression; these toxins may also promote insulin resistance.
Montemurno E, Cosola C, Dalfino G, Daidone G, De Angelis M, Gobbetti M, Gesualdo L. What Would You Like to Eat, Mr CKD Microbiota? A Mediterranean Diet, please! Kidney & blood pressure research. Jul 29 2014;39(2-3):114-123. http://tinyurl.com/y7w54fr5
Uremic toxins also increase intestinal permeability, allowing bacteria and bacteria-derived toxins to enter the bloodstream, which is associated with chronic inflammation, cardiovascular risk, and immune dysregulation.
Ramezani A, Raj DS. The gut microbiome, kidney disease, and targeted interventions. Journal of the American Society of Nephrology : JASN. Apr 2014;25(4):657-670. http://tinyurl.com/yao57qw7
The microorganisms found in the gut are highly influenced by their host’s diet. Some evidence suggests that a high fibre, plant-based diet modelled on the Mediterranean diet could help improve kidney function.
Probiotics and prebiotics may help eliminate uremic toxins. A randomized controlled trial has been proposed to co-administer prebiotics and probiotics to individuals with moderate-to-severe CKD to target p-cresyl sulfate and indoxyl sulfate synthesis, with a wide range of biomarkers being studied to measure the clinical effects of the treatment
Rossi M, Johnson DW, Morrison M, Pascoe E, Coombes JS, Forbes JM, . . . Campbell KL. SYNbiotics Easing Renal failure by improving Gut microbiologY (SYNERGY): a protocol of placebo-controlled randomised cross-over trial. BMC nephrology. 2014;15:106. http://tinyurl.com/ydduz3ek
For overall kidney health a Mediterranean style of eating may be beneficial. Diets high in polyunsaturated fats were shown to significantly decrease risk of CKD in observational studies.
Yuzbashian E, Asghari G, Mirmiran P, Hosseini FS, Azizi F. Associations of dietary macronutrients with glomerular filtration rate and kidney dysfunction: Tehran lipid and glucose study. Journal of nephrology. Jun 5 2014. http://tinyurl.com/ybes9u2h
On the other hand, a large population study showed that those who ate the most saturated fat had significantly higher protein loss from their kidneys compared with those who ate the least saturated fat.
Odermatt A. The Western-style diet: a major risk factor for impaired kidney function and chronic kidney disease. AJP: Renal Physiology. 2011;301(5):F919–31 http://tinyurl.com/y86z4as5
Diets rich in monounsaturated fats may reduce many risk factors associated with CKD; these fats promote healthy blood lipid profiles, improve hypertension, and may improve glycaemic control and reduce obesity risk.
Kumar PA, Chitra PS, Reddy GB. Metabolic syndrome and associated chronic kidney diseases: nutritional interventions. Reviews in endocrine & metabolic disorders. 2013;14(3):273–86 http://tinyurl.com/yb84c68u
To support overall energy and nervous system as well as mental health consider a B vitamin formula.
The following supplements are suggested for you to consider in light of your relevant expertise and intimate understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.
Pro Greens (ARG) – take 1 scoop twice daily – http://tinyurl.com/gtqgbyo
IAG (BRC) prebiotic powder – take 1 tsp twice daily – http://tinyurl.com/jl6rsek
Cytozyme-KD (BRC) – take 2 three times daily
CoQH-CF (ARG) – take 1 twice daily – http://tinyurl.com/gp48znt
B vitamin formula with phospholipids
NT Factor Advanced Physicians Formula (ARG) – take 3 with breakfast and 2 with lunch – http://tinyurl.com/ybsppz4g
I hope this helps with your client
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