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I've been hospitalized in 2012 for dehydration in Jan, Aug, and checked in for the 3rd time on the 28th. Here I sit. All three times electrolytes severely out of norm. This time was potassium requiring 6 bags to get me back to norm. Sodium also but no salt tablets this time. ER doc decided to do a CAT scan on abdomen. I thought odd since I'm in no pain, no fever. Surprisingly he came back and verified I was in no pain, had the contrast I drank caused me any discomfort? No to all. He told me they found areas of inflammation and narrowing in my small bowel. Cut to where we are, some IV low dose steroids, and one bag of Fflagyl. Test wise they want to do a small bowel X-ray, a MRCP, of my gall bladder bile duct, possibly a scope of my small bowel based on X-ray results. It appears the inflammation and narrowing or partial blockage is at the top of my small bowel.

Has anyone else experienced this? Plus I have a dilemma. I am at a neighborhood hospital that is a branch of a large hospital group in Dallas. I contacted my j pouch surgeon before I came in and he said if I had any concerns he would transfer me to the different group hospital in downtown Dallas. Should I hold off on testing here and go to the hospital who handled all my surgeries and knows more about j pouch patients?

Any input or feedback would be appreciated!

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I wish you the best. My tendancy would be to go the facility where they have the most experience in this area which sounds like where your original surgeon is...plus they have all your history....you did not mention if the current hospital/staff has much experience with pouches, etc. You can always go back to the current hospital for a second opinion
S
Low potassium and sodium is typical with diarrhea.

As to the bile ducts, since you have swelling in the upper GI, a peek at the bile ducts makes sense, since they ar in the sm area. Need to rule out Crohn's, and even more important, PSC (primary sclerosing chlangitis). Even post colectomy, all those with UC are at risk. A concern, since it can lead to liver failure or cancer. But, elevated liver enzymes are usually a first clue.

So, long story short, the investgations seem reasonable.

Jan Smiler
Jan Dollar
Here is my update. Went to have ERCP to remove the gall stone from the common duct. Down to the procedure area, due to no BM in 2 days since small bowel series & inability even to pass gas, ERCP cancelled. Discharged 2 days later for a total 8 day stay and 20 lb weight gain due to fluid retention. Have managed to get about 11 of that off thanks to lasix but took last of that today. Still have cankles!
Saw surgeon who performed J pouch surgery yesterday and took him DVD of all my studies from other hospital. He def feels I had a partial obstruction going on causing the ERCP to be cancelled correctly. He feels I should have my gall bladder removed first, and the next day have the GI do the ERCP as an inpatient. He's recommended two Dr. he personally knows, the GI does his wife's colonoscopies! He feels doing it in that order would be less traumatic to the common duct, thereby less chance of complications like pancreatitis. His surgeon recommendation is based on the fact I may not be able to have my gall bladder removed via laparoscopy due to adhesions from the previous surgeries. Sounds like another 3-4 day hospital stay in my near future!
Any input from others having this experience is quite welcome! Thank you!
Txgal58
If you don't have diarrhea and your kidney function tests are OK, then I'd put my money on the prednisone as the cause of your electrolyte imbalance, as one of the side effects is sodium retention (source of cankles) and potassium depletion.

http://www.drugs.com/pro/prednisone-tablets.html

Yet another reason to do whatever you can to eliminate or reduce your need for prednisone. This electrolyte imbalance can have very serious implications, some life threatening. Of course, sometimes you are just between a rock and a hard place and pretty much wind up having to monitor side effects until you can get off the steroid merry-go-round!

What dose of prendisone are you on? And, how was your creatinine (kidney function blood test)? This is a routine test if you are having electrolyte disturbances. If you had a lot of fluid on board, it could just be dilution that lowered the potassium level.

Jan Smiler
Jan Dollar
Thanks Jan! My colon surgeon said I could go ahead and start the tapering off (1/2 tab for 5 days) of the 20mg of prednisone and stop the Flagyl. I weighed myself today and was down is down 14 lbs fully clothed and for the most part the swelling is greatly reduced! If I'm going to gain 20 lbs I want to eat something more than broth!

I have an appt on the 21st with the surgeon to discuss the gall bladder surgery. Sounds like laparoscopic removal will not be for me! Too much scar tissue or adhesions. Yippee! Another incision! Appt next week with new GI to discuss gallstone removal from common bile duct that will take place immediately following gall bladder removal. At least the two docs my colon surgeon recommended seem very highly qualified!
Txgal58
Hmmm...20 mg isn't very much and I would not expect serious electrolyte disturbances from that dose. Maybe they overloaded you with IV while you were there... That can happen sometimes when they overcorrect for dehydration. It is not a mistake, as they go by your blood pressure, but it cam take a few days for your body to adjust.

Jan Smiler
Jan Dollar
It prob was due to overuse of IV because I can't convince them my normal blood pressure is around 100/75. Has been as low as 85/53 laying down after 3 days on IV. I'm perfectly fine at that BP! At 54 I'm lucky this dehydration issue seems to be my only health concern! In fact the BP machine at work often gives me a failure mssg!
Txgal58

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