Posted 8/3/2020 1:05 PM (GMT -8)
Hello and thank-you for all of the great posts and helpful comments on this forum. I am new here and have a few questions.
My brother has been diagnosed with ESLD and has spent the last month in and out of hospital with severe EH, jaundice and ascites, as well as AKI. He had his first bout with jaundice and ascites in the ICU about 2.5 years ago, but after that he seemed to stay off the alcohol for about a year, then he started drinking in earnest again.
He was admitted to the hospital again with a serious strep infection, jaundice, EH in early July (about a month ago) and his kidney function had rapidly declined. However, with IV antibiotics, albumin and paracentesis, he turned things around, which the docs said was surprising - they improved enough for him to be discharged a week later as he was considered "medically stable" - he was going to discharge himself anyway so they let him go. His visit with the hepatologist the following week was not encouraging - she gave him 2-4 weeks to live. They talked about him staying at home with palliative care until he could not be managed, then a hospice room. Two days later he had another paracentesis performed where yet another infection showed up, and he was rushed to hospital - so he was back within 10 days of leaving.
My brother refuses to stay in the hospital. He hates it intensely and refuses to go back under any circumstances - he has decided to die at home and will not stay even for emergency treatment. After 1.5 days he insisted on going home, despite the fact he still had not finished his IV antibiotics. I am going to stay with him in his house and try to help him manage, along with his girlfriend - but I am worried that the oral antibiotics will not be strong enough and that he will downgrade again before we have a chance to get him into hospice care. He has not been able to eat for many weeks and is very weak.
I guess what I am wondering is, given an unresolved peritoneal infection, and the gravity of his condition, what can we expect if his infection gets out of control if the oral antibiotics don't work. How do we as caregivers handle something like this? What might it look like and what do we need to watch for? My hope is that he will pull through this in next few days and will be ready to go to hospice. I am also wondering about diet - I am aware of the salt restrictions but is there anything that people have tried for his advanced state of malnutrition...I am arriving there tomorrow and would like to see if I can get him to eat so he can gain some strength. I think he drinks mostly juice.
Thanks in advance for the response.