Patient's Query
Hello doctor,
My 75-year-old mother has contracted norovirus at her nursing home, which is experiencing an outbreak. She has had severe vomiting and diarrhea for almost 36 hours. The nursing staff says other residents have the same symptoms, but my mom seems worse than the others. She takes Warfarin for atrial fibrillation with a target INR (international normalized ratio) of 2.5 to 3.5, and I am concerned that dehydration could affect her levels. She is also on Furosemide for congestive heart failure but has not been able to take any of her regular medications because she keeps vomiting.
Her latest vitals were: temperature 101.3°F, heart rate 118, and blood pressure 102/68 (which is low for her). She is becoming confused and did not recognize me during a video call today. The nurse mentioned her skin seems 'tented' when pinched, and her urine is very dark and concentrated. Mom also has chronic kidney disease (stage three) with a baseline creatinine level of 1.8, and I am really worried this could lead to acute kidney failure. The facility doctor has not seen her yet and just ordered Ondansetron, which she cannot keep down. Should I push for her to be transferred to the emergency room, or should I give it more time? How dangerous is norovirus for elderly patients with her conditions? What should I be asking the nursing staff to monitor closely?
Kindly help.
Hello,
Welcome to icliniq.com.
I understand your concern.
Given her age, health issues, and severe symptoms, it is important to act quickly. Norovirus can be especially dangerous for older adults, particularly those with heart failure and kidney disease.
The symptoms you mentioned—severe dehydration (shown by tented skin and dark urine), confusion, and not being able to keep medications down, are concerning. Dehydration can affect her INR (international normalized ratio) levels and worsen her kidney function, possibly leading to acute kidney failure.
I strongly recommend pushing for her transfer to the emergency room right away. In the hospital, they can give her IV (intravenous) fluids to treat dehydration, closely monitor her vital signs and kidney function, and manage her medications more effectively.
When talking to the nursing staff, ask for the following:
Regular checks on vital signs (temperature, heart rate, blood pressure).
Frequent assessments of hydration (urine output, skin turgor).
Monitoring of INR levels and kidney function.
Ensuring she gets enough fluids, possibly through an IV (intravenous) if she can not keep anything down.
Time is critical, so please make sure her situation is closely monitored.
I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.
Thank you.
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Answered byDr. Srinivasa Murthy
Medically reviewed byiCliniq medical review team
Same symptoms don't mean you have the same problem. Consult a doctor now!
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