Published Jan 22, 2005
I had a 76 y/o patient yesterday who went down for a colonoscopy even though he had not been properly prepped. He had not had a stool in a week and the CT revealed a mass obstucting his colon. The doctor ordered tap water enemas before the colonoscopy just to prep what we could. The tech gave him a total of 6000cc of tap water enemas (actually an agency RN) with just clear return. No c/o's per patient re pain or anything.
He came back from the procedure and the doctor told me that he had a large mass that was CA and that the radiologist had told him that it was metastisized to the liver. Upon returning to the room he began vomitting fecal material (approx 750-1000cc), so as ordered I dropped an NG and immediately got a 600cc return of more fecal material. I left the suction on med/intermittant and shortly after lowered it to low/intermittant. About 2 hours later I was paged to his room. He was having the hard shakes and c/o being cold. His temp was 98.2 and all VS were normal. I put him on a dinemapp for Q 5 minutes and the VS and temp remained normal. I called the doctor who ordered a CBC and BMP. By the time I got back to the room a total of 15 minutes or so had gone by since he first started shaking. He was no longer shaking, VS still normal, he said he felt better but he looked awful, greyish.
It was 1945 and I went home so I don't know how the CBC and BMP turned out. I went to the night nurse and gave her a complete update on what had just happened. Any thoughts on what might have been going on with him? Anxiety r/t dx ? Internal bleeding r/t colonoscopy? Drop in potassium r/t suction? His CBC and BMP were normal that AM. The only abnormal he had was a BUN of 35. Creat was WNL.
DutchgirlRN, ASN, RN
RNPATL, DNP, RN
From my perspective, I would think that maybe the fluid loss had something to do with his shaking. I would wonder what his soduim was afterwards. 700-1000cc from the NG tube is quite a bit of fluid to lose and perhaps his body was responding to this. Of course, he may have been having an anxiety attack also. But I would be suspect of the fluid loss as the problem. That is just my opinion.
Im not thinking about the 1600 or so of fluid loss, as i am the trauma of having so much tap water enemas and then a colonoscopy( with colon cancer). I was thinking it may have been a nerveous reaction ( maybe even involving the vagus nerve) that caused this period of afebrile trembling.
I had a patient the other night who did some "hard shaking." I took a blood sugar strip and tested it. It said "low-below 20. I thought she was going to die on me but she didn't. She's a diabetic who usually has blood sugars in the 200-300 range.
Chills? Maybe he was just cold?
SE of recovery from anesthesia?
And what's with the tap water enemas? Even if he was obstructed, tap water would have pulled lytes and left him deficient. Don't know if that could cause the shaking, but if it was neurological, that could make some sense.
Poor guy. Sounds like he has been ignored a very long time.
When I went back to work my patient was in the unit. His CBC & BMP had been normal and he had had no more shaking. I talked to the doctor who seemed to think he was having an anxiety attack of sorts. He was scheduled for a colon resection but ended up with the whipple procedure and I was told that the cancer had metastisized thru his whole abdomen, liver and pancreas included. So sad......
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