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Q. My 80 years old father has loss of appetite and lost 6 kg of weight. Please help.

Answered by
Dr. Sugreev Singh
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jan 03, 2021

Hello doctor,

My father is 80 years old. He has lost around 5 to 6 kg of weight for the last six months. Now he is weighing about 44 kg. He has a weakness for the past six months. Please advise.

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Hi,

Welcome to icliniq.com.

The reason for such weakness and weight loss can be due to long standing infection in the body such as respiratory tract infection or hepatitis.

How old is your dad and what is his body weight? How many kg he has lost and in how many months? Since when he has weakness? What medicine is he taking currently?

Please send me his reports I will check and let you know further. Also, please answer these questions so I can prescribe you medicine.

Thank you doctor,

He is taking Telma 40 twice a day, Minipress 2.5 once at night, Glycomet GP .5 once a day and Razo D in the morning. Please go through the blood report.

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Hi,

Welcome back to icliniq.com.

I have gone through the blood reports (attachment removed to protect patient identity). Specific changes are there, such as decreased lymphocytes and increased eosinophils, which can be due to allergic reaction. Other changes were increased alkaline phosphates, which indicates infection of the liver or gallbladder. A few other changes such as decreased LDL (low-density lipoprotein) cholesterol, creatinine, and uric acid are not significant, so if we treat the underlying condition, allergies, and liver infection, then there will be an improvement.

Can you please tell me about his appetite? Is he able to eat well? Is there any difficulty in breathing? Do you have pain in the abdomen area, specifically on the right side below the ribs?

Thank you doctor,

His appetite is decreased. No difficulty in breathing and no abdominal pain. He has stone in gall bladder, but no pain since eight years. He had a fall last year and fractured his distal radius of the left hand. He has gone through surgery. At that time he has low sodium level due to blood pressure medication Olmesar CH 40.

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Hello,

Welcome back to icliniq.com.

For now, please give syrup HepaMerz 100 ml, 3 ml once a day for ten days, tablet Cetirizine 10 mg once a day after meal for five days. If anything, please let me know. Give enough fluids to him.

HepaMerz OA syrup will help with appetite and liver, while Cetirizine will help in an allergic reaction.

Thank you doctor,

Is the dosage is 3 ml? Should he take after food or before food? Before a few months, he had a urinary tract infection. For which he has taken antibiotics as per the culture report with the consultation of the doctor. Subsequently, his urine culture was done twice, which shows no infection. His eosinophils were high at that time also. He had taken Diethylcarbamazine forte for five days.

Also, he suffered a fever with severe joint pain. After that, his blood and urine tests were done. I am attaching his CBC report. Why his appetite was greatly reduced, and why his eosinophils are remaining high? Is there any worm /parasite infection?

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Hello,

Welcome back to icliniq.com.

As we can see, eosinophils were high, suggesting persisting allergies, such as allergies to dust or pollen, which usually leads to sneezing or runny nose. Or sometimes difficulty in breathing or respiratory tract infection. As you mentioned, you had a history of urinary tract infection. Does he have any signs of urinary tract infection still? Like dark color urine or frequent urination or burning sensation during urination? In such a case, we can repeat the urine test. If he does not have any symptoms, then continue with Cetrizine 10 mg and HepaMerz it will help in case of allergies or decreased appetite

Thank you doctor,

When should he take 3 ml of HepaMerz, after food or before food?

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Hello,

Welcome back to icliniq.com.

Take it after food in the morning.

Hello doctor,

Thank you for you kind help.

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Hello,

Welcome back to icliniq.com.

You are welcome. Keep in touch for further doubts.

Hello doctor,

My father is 80 years old. He has elevated blood pressure about 160-170 /90-98 during winter. His blood pressure was normal during summer. He is taking Telma 40 twice a day and Minipress 2.5 at night. Can a new medication be added?

#

Hello,

Welcome back to icliniq.com.

If culture is normal then do not worry. The strong smell can due to dehydration when a person drinks less water. Then such a smell can be present. Give him water properly.

What complaints does he have currently?

Hello doctor,

My father is 80 years old. He has elevated blood pressure about 160-170 /90-98 during winter. His blood pressure was normal during summer. He is taking Telma 40 twice a day and Minipress 2.5 at night. Can a new medication be added?

#

Hi,

Welcome back to icliniq.com.

He is taking Telma already twice a day and Minipress. So can you tell me, even after taking Telma, does BP stay at 170/100 mmHg? I would suggest you decrease salt from the diet.

Hello doctor,

Yes, even after taking Telma and Minipress, BP stays at 170/100? It is happening in winter only. Salt intake is also low. Please suggest any additional medicine. I have attached his recent blood reports.

#

Hello,

Welcome back to icliniq.com.

His current reports are normal except for a few changes (attachment removed to protect patient identity). There is decreased RBC and slightly decreased hemoglobin and increased ESR. Apart from that, slight changes in PCV and all noticed which are not significant.

RBC and hemoglobin decrease in case of anemia, so I would suggest you give him Dexorange (Iron + Vitamin B12) tablet once a day before meal for seven days. Please check his pulse and let me know.

Does BP rise every winter? Is he taking any medicine for sugar?

Thank you doctor,

His pulse rate is above 90. BP rises every winter. He was talking Glycomet GP .5. Due to a fall in sugar level, he is not taking any sugar medicine.

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Hello,

Welcome back to icliniq.com.

Does he have any symptoms like headache or irritation?

Thank you doctor,

He is irritated, but do not have headache.

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Hello,

Welcome back to icliniq.com.

Give him Telma 80 mg once in the morning and evening continue with Telma 40 mg. Let me know his blood pressure after giving Telma 80 mg.

Thank you doctor,

Total dose of Telma is 120 mg/day. 80 mg in the morning and 40 mg in the evening. Will it exceed the maximum dose? He is also taking Minipress 2.5 at night.

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Hello,

Welcome back to icliniq.com.

No, it will not exceed maximum dose and if three continuous BP recordings are high then we have to increase the dosage and see. If it is still high then medicine should be changed. If he does not have much symptoms then 40 mg twice a day is sufficient.

Thank you doctor,

Shall we give Telma 80 in the morning and Telma 40 in the evening and Minipress 2.5 at night.

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Hello,

Welcome back to icliniq.com.

Just monitor his BP in the afternoon after giving Telma 80 mg. If in the evening also high then let me know.

Thank you doctor,

I will also monitor his sugar level. At what sugar level should he start medication?

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Hello,

Welcome back to icliniq.com.

If fasting is more then 110 and after eating if it crosses 150 mg/dl.

Thank you doctor,

I will contact you after checking his BP and sugar in the evening.

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Hello,

Welcome back to icliniq.com.

Let me know his sugar and BP readings.

Thank you doctor,

His blood pressure at 4 PM -155/91 and at 7.30 PM 164/95. Sugar at empty stomach 136 and two hours after meal 180 mg/dl. Should he start sugar medicine Glycomet GP .5?

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Hello,

Welcome back to icliniq.com.

It is fine you do not have to increase the dosage just start sugar medicine. And digital BP apparatus shows elevated BP sometimes. So if the patient does not have any symptoms you should not be worried.

Thank you doctor,

My father was taking Glycomet Gp .5 and Glimepiride .5. His HbA1c report is attached. Will he continue the same dose or any dose reduction required? Is metformin responsible for weight loss? Can only Glimepiride or metformin be given? Another problem he is facing is weight loss.

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Hi,

Welcome back to icliniq.com.

Can you please tell me, what was his previous HbA1c levels?

Thank you doctor,

It was below 5 before nine months.

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Hello,

Welcome back to icliniq.com.

Continue with the same dosage. Metfromin is not responsible for weight loss. You should continue with as it is. No changes required.

Thank you doctor,

I am greatful to you.

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Hello,

Welcome back to icliniq.com.

You are welcome. Keep in touch for further doubts.

Sir one thing I forgot to mention that on 26 th December my father after coming from outside sat on sofa .After some time he failed to get up from sofa and become some how unconscious.Saliva was coming from his mouth.He was given salt and sugar water.After that he became OK.His sugar level was checked.Found 110.and his bp was 107/65.This happened around 1 pm.He had taken all his medicine for bp and sugar in the morning. Sir what may be the reason?His blood test was done the next day which you have checked already

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Hi Welcome back to icliniq Thank you for writing and replying back quickly Sir main reason for such condition is due to anemia as you can her rbc count is low so this may be reason for his weakness and fainting so I would suggest you to give him more healthy diet which includes fruits and vegetables. So his rbc will increase and he will feel good. His anaemia is cause for hist weakness so you have to treat it by diet. If anything else let me know Thank you


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