please help me understand

ageless · Jul 11, 2005

I very sorry for the loss of your Mom.

Although she had chronic lymphoma, it sounds like the immediate underlying things were her heart and kidneys. She was also being treated for an infection which lead to sepsis causing the casade of multi-organ failure.

By what you have written, It sounds like the infection caused hypo-perfusion and/or perfusion abnormalities (enhanced by CHF) leading to an increased acidotic state, which is under the umbrella of uremia (enhanced by the kidney failure) which lead to death.

I hope this is helpful.

jnette, ASN, EMT-I · Jul 11, 2005

Monica.. I am so very sorry to read this.

My father, too, died of non hodgkin's lymphoma at the young age of 63. That was 27 years ago. He, too, developed CHF and in the end, that was what caused his demise.. and what was written on his death certificate.

He went into remission for eight years after being diagnosed, but I still vividly remember him mentioning that should he ever develop an infection, or URI, that it would be a downhill slide from there. He was always very careful not to get near anyone with a cold, etc. But in the end, he did, and it was as he said.. a downhill slide, and a very quick one, just like with your dear Mom.

One minute he was in the hospital with the respiratory infection, the next they were air evaccing him across the ocean to Walter Reed with CHF.. he passed away over the English Channel.

I agree with ageless... I believe she has described the cascade of events and comorbidities perfectly.

Again.. I am so very sorry. (((((((((((HUGS)))))))))))

cutenurse34 · Aug 15, 2005

Thankyou for reading this.......
I will try to keep this brief (it will be difficult)
On April 28th I lost my Mother.
She was 67 yrs. old, she had battled ( and kept at bay) non hodgkins lymphoma for the better part of 20 yrs.(amazing)
She had Congestive Heart Failure, and only one "functioning" kidney,
over the years of her battle she has had numerous rounds of tests, treatments, interventions , ie: abdominal parenthesis (weekly) for months.
etc. (too mauch to list)
her heart problem inevitably created kidney problems, but she was monitered closely. she went to a wonderful University hospital, even though it was an hours drive. shes been doing good for some time going for weekly procrit shots.
In March she went for her weekly procrit shot, she had
been having diahrrea, and was found to be dehydrated with very low blood pressure.
They admitted her, stopped all her meds (heart blood pressure etc.)
Began hydrated her slowly, and she swelled. they discovered her kidney was not functioning well, and ultimately deemed it as failure.
also, they found she had a blood infection, (staph i think)
treatment included...
jugular catheter placement for immediate dialysis
and vanco for the infection.
she was passing blood through her rectum so they did an endo to see why,
and could only suggest perhaps it was gastroenteritis, irritation.
the day after the endo my mom appeared to have a mild stroke, but thankfully, no damage or signs of it the next day.
finally after 2 weeks of hospitalization they removed her porta cath from former chemo treatments because they felt that was causing the infection. It cleared and she was released, but could not have dialysis at the university because she lived too far, they would not allow her to travel that distance. (?)
so...
she had to go locally (yuk)
they squeezed her in for her thrice weekly dialysis.
she did this for 2 weeks
on wednesday of week 3, her 8th time to this unit she went in telling them she was freezing and not feeling well they did cultures, dialysis and sent her home.
I went over her house and stayed with her till 1 a.m, she was shivering cause she was cold,sleepy and had a mild fever (100), Dad had the flu shortly before she came home so he and I assumed on top of all else poor Mom was getting it.
she was cold and weak, same symptoms he had.
She shivered and moaned and was unres[ponsive ( I thought cause she was feeling ill) in the chair and finally went to sleep , so I came home at 1.
My dad called me at 8 am to tell me she was unresponsive, I told him thats how she was during the night, again when my Mom is sick she closes her eyes and doesn't want to be bothered, so .... this is what I assumed was happening.
I told him as soon as the boys get on the school bus I will be there.
8:15 he called back to say , no need to hurry.
My Mom passed away .
OMG
fast forward to now, the whirlwind is slowing and I am at total peace with my Mom not suffering anymore.
but........
after ALL she has been through I cannot believe what she died from
I thought her heart failed
nope
her death certificate, which I just read for the first time says her cause of death was Septicemia & Uremia
I am not a Nurse (yet...aug 30th is my orientation)
but help me to understand how if she was having dialysis, how could she have uremia? again I am at peace I just am confused....
and as far as septicemia..... I just am confused.
Thabks if you have read all this and any response is welcome.
take care, Monica

Sorry about your lost honey.

Septicemia is very common in dialysis, especially in pts with a temporary access (catheter) due to sometimes contamination from healthcare worker (not wearing mask or putting one on patient, not covering the connection areas with a substances such as betadine or just poor hygiene) your mom being immuno compromised from the cancer and ESRD was at even greater risk.

As for the uremia, it could be the fact that she was still new to dialysis, poor blood flow from cath, wrong size dialyzer, not enough hours on dialysis, just plain inadequate dialysis.