How to manage Parkinson’s with persistent vomiting?

Question

Hello doctor,

I am very worried about my husband, 62 years old, who has been very sick with norovirus for the past three days. He cannot keep down his important medications because of constant vomiting and diarrhea. He has Parkinson’s disease and heart failure and takes 12 different medicines every day, including Carbidopa-Levodopa and Amantadine for Parkinson’s, and Furosemide, Carvedilol, and Sacubitril-Valsartan for heart failure (his ejection fraction is 35 percent).

He has missed three days of all his medications due to the vomiting. Now, his tremors, stiffness, and confusion are getting worse, which I think is because of missed Parkinson’s meds. He also has more leg swelling and shortness of breath, likely from missing his heart medicines. I called his neurologist, who was concerned but only advised me to restart the meds when possible, which is not helpful since he keeps vomiting everything.

He managed to have a few sips of electrolyte solution but no medications. His usual blood pressure is about 130/76 with meds, but this morning, it was 110/65.

When should we go to the emergency room instead of waiting? Would crushing his Parkinson’s medicines and mixing them with a small amount of applesauce help him absorb them better? I am scared he will get worse quickly without his medications.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

This is a difficult situation. Your husband’s Parkinson’s disease and heart failure need regular medication to keep him stable. But right now, because the norovirus infection is causing vomiting and diarrhea, he cannot take his medicines by mouth.

As you noticed, his worsening tremors mean his Parkinson’s symptoms are getting worse. The increased leg swelling and shortness of breath show that his heart failure is also getting worse. Both problems are likely because he has not been able to take his medications.

In this case, taking your husband to the emergency room (ER) right away is very important. At the hospital, doctors can treat his vomiting and diarrhea with medicines given through an IV (intravenous). Once his symptoms are under control, they can safely restart his heart failure and Parkinson’s medications by mouth. If needed, doctors can also give medicines for Parkinson’s and heart failure through IV (intravenous).

Leg swelling (pedal edema) means fluid is building up in the body, while vomiting and diarrhea cause fluid loss. Having both at the same time is serious and requires a doctor to examine the patient carefully. The doctor will decide when to give IV fluids for dehydration and when to give medicines like Furosemide to reduce fluid buildup.

Blood tests will also be needed to check for problems like electrolyte imbalances, kidney issues, infection, or acid-base problems. All these essential checks and treatments can only be done correctly in a hospital.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.