What would cause this?

[OrganizedChaos]

What would cause bloating prior to death? I tried to look up this answer on Google but I can’t find an exact answer.

Patient was at home, said didn’t feel well & then a family member told me that the pt.’s abdominal area was swollen. I don’t know what made the abdominal area swollen. Was it gas? Was it liquid? What would cause the pt. to fall down so suddenly & die? The pt. had been to the doctor prior for illness & they gave her antibiotics.

I am just at a loss because it happened so suddenly & unexpectedly.

[OrganizedChaos, LVN]

3 hours ago, thenewspirit said:

You are asking in the wrong place. The patient should have called 911, but nobody knows the whole story since the primary source (the patient) is deceased and no autopsy will be performed. I would imagine the patient was not reporting all symptoms and had an underlying condition which caused sudden death. Bloated abdomen may or may not be related to the cause of death. It may have been a suicide and the family does not know.

Just educate your patients and their families when to call 911, and move on. You can attend the funeral if the family invites you and make a donation after the funeral if you want.

I am sorry this happened to you, but it is nobody’s fault from the information you have given and we have to be objective.

You hit the nail on the head & I love this reply. I was just trying to make some sense of it since the bloated abdomen seemed odd. My patient was the type to keep health issues quiet, not go to the doctor & not take medicine as prescribed.

There is no telling what the cause of death was & we really will never know. I feel bad for my patient’s family. From what I heard it was fast, so that is the best thing.

Thank you all for your wisdom & input.

ETA: They did call 911 & they tried to revive my patient but it was unsuccessful.

[adventure_rn, MSN, NP]

My first thought is that edema (including ascites/truncal edema) can be a side effect of the dying process itself, regardless of the cause (bleeding, perf, PE, sepsis, etc.). When you're actively dying and in multisystem organ dysfunction, your kidneys are quite sensitive and are often the first to go, so fluid retention is common.

Like @thenewspirit said, you're never going to know, especially since the people reporting the symptoms are family members; they aren't trained in medical assessment, so who knows how long the abdominal distention was going on before it got bad enough to the point that they noticed, or what other warning signs they might have missed. The unfortunate truth is that you'll probably never know the whole story, especially without an autopsy.

I do hope you can find peace in all of this. I'm sure it's distressing not knowing why a patient keels over and dies (my most haunting code events have transpired that way), but you'll drive yourself crazy going through every possible scenario without the right background information. If you were in an inpatient setting, this would be an ideal case for an morbidity and mortality (M&M) conference. Unfortunately, sometimes we just don't know.

I do think it's really sad that the family is forgoing an autopsy because of the cost; I'd imagine that having some answers would help bring them peace as well. ?

[Workitinurfava, BSN, RN]

Release of sphincters or muscles. Bacteria also has a hand in this I think. It's not uncommon in death.

[VivaLasViejas, ASN, RN]

My husband had pancreatic CA with mets to the liver, which caused some bloating. The night he died, his abdomen blew up suddenly and became severely distended; then he began to vomit frank blood in huge amounts. He lost at least a liter of blood (he used a barf bag and filled it up) and went into shock. The distension was almost immediately relieved, but the dying process was in motion; he passed away within hours of these events.

Not that this has anything to do with the OP's patient, it's just another one of the many things that can cause someone's abdomen to become distended.