Question:
An elderly patient was admitted due to decreased general condition anddiarrhoea. She has dementia, parkinsonism and anemia. ECG shown sinusbradycardia with AR~55/min., urine with RBC +++ve, serum K 3.4, Hb 7.6.The medical officer prescribed IVF 1/2:1/2 Q8H/pint with 10 mmolKCl/pint and NPO. So, why don't they treat the anemia?

Can anyone give me some suggestions???

Answer: my guess is that she was dehydrated from her diarrhea, and with herdementia and parkinsonism most likely was taking poor PO fluids as well(just a guess, as I have not seen this paitent, but have seen MANY othercome in from the nursing home during the heat of summer). Assuming thatshe is clinically dehydrated (can not tell with out looking at her) andnot actively bleeding, IVF would be a good first order. You could topher off with some NS (or 1/2NS), start to correct any electrolytes thatyou need to, and then after she is more stable think about giving herblood when you figure out why she has a anemia (in fact you would do mostof this at the same time). As you rehydrated her you would have to keepan eye on her HGB to make sure you do not make her more worse by dilutingher blood out more.

You would also need to better assess they type of anemia she has beforeyou go trying to treating it. You would do things differently if thiswas an anemia of chronic disease, or if it was from renal failure, orfrom the GI bleed that you may have missed while getting hot about theblood in her urine, or from a 100 other things. Who knows why she hasthe blood in the urine. Maybe she has a UTI from a catheter (or maybeshe tried to pull one out before you saw her) or maybe her anemia andblood in the urine are from kidney tumor. In the end the first thing todo is stabilize her with fluids then then sort the rest out after that.

This also brings up a very good question of if you should be doinganything at all. If this patient is a end stage dementia patient, itmight be very reasonable to just not treat the dehydration at all and lether die. There are far worse ways to go and it would be very reasonableto talk this over with the family. For these type of patients you cankeep them very comfortable till the end.