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What happened to your home meds?

People are always very concerned about what is going on with their home medications while they are an inpatient.  I cannot tell you how many times patients or family members have been upset thinking the doctor is doing something wrong in stopping or changing the home medications when a patient is acutely ill.  And I assure you, most likely there is a good reason behind the changes. 

Sometimes home medications are stopped.  Sometimes new medications are added.  Sometimes pain medications are adjusted. 
There are many reasons why home medications might be stopped while inpatient.
For example, maybe with the current situation, the blood pressure is running low.  In that case blood pressure medications will be held.
Maybe the patient now is confused.  This is called altered mental status.  If so, many medications can lead to confusion.  Psychiatric medications, dementia medications can lead to confusion in certain situations.  Often times we stop these when someone arrives to the hospital.

Confusion also accompanies dehydration, which leads to renal failure.
If the home medications are metabolized (processed) by the kidney and the patient has kidney failure, those medications become toxic and can lead to change in the mental status (confusion).  If the kidney can not process the medication then the dose of the medication changes.  A dose that worked for normal kidney function can become toxic when the kidney function is declining.
The same becomes true of pain medications and insulin.  Most of these are processed by the kidney.  So dose adjustments to lower dosage is needed.

If the patient cannot swallow or it is not safe to eat, medications will be changed to IV formulations.

Medications will be added back in a systematic plan as the patient's condition improves.

Be assured that the doctor is assessing the risk of continuing these medications versus the benefit when one is acutely ill.  And as always, if there is questions about the medications, feel free to ask the nurse or the doctor.

As we age, the longer it takes to go back to the normal mental status.  This is not because medications have been changed or held.  But it usually is because our bodies take longer to get rid of the toxins caused by the current condition.  We get rid of toxins in her body so our liver and kidneys.  Our brain just take a little bit longer to go back to normal after such big insults to the system.

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