Saturday, April 24, 2010

When Ca-Ca Fails to Occur

A nephew of mine, a young one, wound up hospitalized recently due to a lack of doo-doo. Okay, not really a lack but a failure for it to appear. He was seriously constipated. Extended periods of time with no bowel movements, and the nasty stuff we want on the ground can become even nastier inside of a GI tract. And fatal cases of constipation are not that unusual--although they are usually related to drug use and more common in the elderly. It is not out of the question, however (and it has happened), that you could face an evacuation decision (stay or go) when your assessment is constipation. The patient typically reports several days of inadequate hydration. You may have to curiously dig for more info than the standard SAMPLE history will supply, going back over a week of history. High fat diets (say cheese) and low dietary fiber may also contribute to constipation. Combine those factors in someone who is hesitant to squat in the wild outdoors, and you have a formula for serious constipation. You can try increasing hydration for the patient, adding fiber, stimulating the bowels with caffeine or alternating cold fluids with hot fluids. But if vague abdominal pain in the lower quadrants increases, perhaps becoming less vague, and especially if a fever develops, you have someone on your hands who needs to be in other hands--those of a hospital-based physician. My nephew, by the way, seems to be on his way to wellness, thank you.

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