Does low hemoglobin and prolonged periods of hospitalization cause mental confusion?

Question

Hi doctor,

My dad was hospitalized over five weeks ago because he was dehydrated by a stomach virus. He was so dehydrated that his kidneys shut down, and his blood work was abnormal. He was put in the MICU, on the ventilator, and given a sedation called propofol. He was then given six treatments of dialysis. His kidneys finally started working again, and he no longer needed dialysis. All his blood work started to come down back to normal. When they started to ween him from the ventilator, he did well and came off of it. Then after three days, he had problems with mucus in his lungs and developed a mucus plug. They had to put him back on the ventilator. They had to go in and do a bronchoscopy. He was then on the ventilator for three more days and came back off. He has since been woken up but is not himself at all. His hemoglobin is 8 g/dl, and he is so weak. He is still on a liquid diet, causing him to be weaker. Before he went into the hospital, he was on an iron pill. They transported him to rehabilitation, but he is too weak to do anything and is still very confused and not himself. Before this, his mind was good, and he did everything normal would do. What could be causing the low hemoglobin and his confusion?

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I have gone through the history provided here. Sorry to hear about your father's illness.

For normal functioning of the kidney, it needs an adequate supply of fluid. Your father had dehydration. Hence acute renal shutdown occurred, and dialysis was done for that. The kidney produces erythropoietin which is necessary for RBC production. The second kidney filters waste products and remove them from the body. Hence toxic substances are removed, and the body can function normally. Now as your father has kidney failure, erythropoietin production and toxic substances filtration are hampered. So because of less erythropoietin, a low hemoglobulin level was there. And because toxic substances are not filtered, it can lead to confusion, like neurological symptoms. Dialysis effectively removes toxic substances, but sometimes full recovery might take time. Management of kidney failure is complex. Arterial blood gas analysis was done to rule out acidosis, and if needed, sodium bicarbonate was given.

Potassium filtration also affects kidney failure, so if serum potassium is high, glucose infusion or potassium-binding resin is needed. Calcium levels also should be maintained. Hydration should be maintained. Your father had mucus production. Hence respiratory tract infection might be there, for which he might have been given antibiotics if needed. For anemia, if needed, erythropoietin can be given to stimulate erythropoiesis.

Under strict nephrologist observation, prescribed treatment continued.

I hope your father will recover fully soon.

Let me know if you have any further queries.

Thank you.