Will Hydromorphone mask the recovery of an elderly patient with COPD?

Q. Patient is 89 years old with COPD. Is Hydromorphone a recommended analgesic?

Answered by
Dr. Ashok Kumar
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Nov 05, 2019 and last reviewed on: Jun 21, 2023

Hello doctor,

The patient is 89 years old and unable to take medications orally. The patient has COPD (with a pacemaker), CCF (congestive cardiac failure), had two TIA's a few years ago and is type 2 diabetic, has delirium, and is in pain. The patient is on iv antibiotics and diuretics.

1) Is it typical not to use Hydromorphone (or alternative analgesia) for pain if a patient is on antibiotics for suspected sepsis and probable pneumonia, on the ground that the Hydromorphone could mask the symptoms of the patient's recovery or decline?

2) Is some other analgesia less likely to disguise such symptoms?



Welcome to icliniq.com.

It is not advisable to withhold pain medication while the patient is on multiple antibiotics for the treatment of sepsis. As the patient is suffering from COPD (chronic obstructive pulmonary disease), the use of Hydrocodone is not advisable as it causes respiratory depression in an already compromised patient, but the patient should be prescribed alternative analgesia due to the following reasons.

First, it is inhuman to allow suffering due to pain. Secondly, pain itself a cause to maintain the delirium and prevents recovery from it. Thirdly, the recovery from sepsis can be determined by clinical examination and routine blood count. I agree that Hydrocodone can mask the symptoms but there are other pain medications which are safe and can be used in patients.

Even a simple iv infusion of Paracetamol can be used for pain relief, and it also works as an anti-inflammatory agent. I hope this helps.

Thank you, doctor,

As a matter of interest, what sort of clinical examination or blood test results would determine whether the patient is recovering or declining? Despite suspected sepsis and pneumonia, two blood cultures were negative.



Welcome back to icliniq.com.

There is no specific diagnostic test for sepsis. Diagnostically sensitive findings in a patient with suspected or proven infection include fever or hypothermia (temperature below 96.8 degrees fahrenheit generally more common at extremes of age), tachypnea (respiratory rate >24), tachycardia, and leukocytosis (total white blood cell count >12000) or leukopenia, acutely altered mental status, thrombocytopenia, an elevated blood lactate level, or hypotension also suggest the diagnosis.

It does not mean that all should be present in a single patient. The presentation of sepsis is very much variable but on careful observation of all mentioned clinical and biochemical parameters one can reach the diagnosis.

Serial monitoring of the above parameters will tell you the condition of the patient. If the patient improves one or another parameter it indicates the improving status of the patient. If there is deterioration you can suspect that the patient is not responding to current treatment and needs a different set of treatments including antibiotics. These things are easy to monitor clinically or with the help of a simple laboratory which will determine the number of leukocytes, thrombocytes, and lactate levels.

The presence of sterile culture does not mean that there is no sepsis. It may be present due to prior antibiotic administration, the presence of slow-growing organisms, or the absence of microbial invasion of the bloodstream. Statistically, only 30-50% of patients with sepsis have a positive blood culture. In these cases, Gram's staining and culture of material from the primary site of infection or infected cutaneous lesions may help establish the microbial etiology.

I hope this helps.

Was this answer helpful?


Same symptoms doesn’t mean you have the same problem. Consult a doctor now!

Related Questions:
What is the cause of my recurrent strokes and TIA?

.. antithrombin 3 and D-dimer levels are a direct consequence of the stroke you suffered and the many TIAs. High fibrinogen levels are associated with an increased incidence of blood clots. The treatment that you are receiving currently is to prevent the   Read full

Can kidney get affected in a diabetic patient?

Your sister is a known case of hypothyroidism with uncontrolled type 2 diabetes mellitus ... Diabetes ...   Read full

What is the treatment for COPD?

.. said your father has COPD, low oxygen levels are expected when the disease is advanced. COPD is a chronic progressive disease. Inhaler medicines are only for the symptomatic relief. Smoking cessation is the best policy to halt the progression of the di   Read full

Also Read Answers From:

ideaComprehensive Medical Second Opinion.Submit your Case

Also Read

PCOS and Liver Problems
The hormonal imbalances in polycystic ovary syndrome could cause liver diseases. Read the article to know the relationship between these medical conditions.  Read more»
Inferior Alveolar Nerve Lateralization Technique
The inferior alveolar nerve lateralization technique is a surgical lateralization technique to reposition the nerve. Read the article to know more about this.  Read more»
COVID-19 and Ebola: Similarities and Differences
This article gives a comparison and broader overview of the outbreak of the two deadliest diseases that showed a greater incidence over the last two decades.  Read more»

Ask your health query to a doctor online?

Ask a Geriatrician Now

* guaranteed answer within 4 hours.

Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.