From the Guidelines
I strongly recommend seeking immediate emergency medical care for your father, as his symptoms indicate a critical condition that requires professional medical intervention. His low blood pressure (77/57), jaundice (yellow skin), edema (bloated legs), and confusion (saying random words) suggest severe complications from his advanced cancer, which may indicate liver failure, causing high bilirubin levels and mental status changes 1.
Administering cortisol without medical supervision is not recommended and could potentially worsen his condition, as it may have adverse effects, such as insomnia, and its benefits for cancer-related fatigue are still conditional, with low evidence quality 1. Palliative care teams are equipped to manage these symptoms appropriately with the right medications and dosages, providing proper pain management, anti-nausea medications, and other supportive care to improve his comfort.
Your father's blood pressure is dangerously low and may require IV fluids or vasopressor medications that can only be administered in a medical setting. The confusion he's experiencing (encephalopathy) is likely due to toxin buildup that his liver can no longer process, requiring medical management beyond what can be provided at home. While I understand your desire to help your father, the most compassionate action now is to contact his palliative care team immediately or call emergency services, as they can provide appropriate interventions focused on his comfort and dignity during this difficult time, in line with the principles of palliative care, which prioritize symptom control, psychological, social, and spiritual support 1.
Some key considerations for his care include:
- Managing his pain and discomfort
- Controlling his nausea and vomiting
- Addressing his fatigue and weakness
- Providing emotional and spiritual support
- Ensuring his safety and preventing further complications
It is essential to prioritize his comfort and dignity, and seeking immediate medical attention is crucial to achieve this goal.
From the Research
Palliative Care for Stage 4 Metastatic Colonorectal Cancer
- Palliative care is specialized medical care for people with serious illness, focusing on improving symptom management and addressing the needs of patients and families 2.
- The goal of palliative care is to optimize physical, psychosocial, and spiritual symptoms of patients and their families whose quality of life is impaired by serious, life-limiting illness 3.
Symptom Management
- Aggressively managing symptoms can improve the quality of life for patients and loved ones, regardless of how much time they have remaining 4.
- Palliative symptom management approaches disease in a holistic manner, addressing not only the physical aspect of symptoms but also the psychological, social, and spiritual dimensions of suffering for total symptom relief 4.
- Common symptoms in palliative care include pain, nausea, vomiting, depression, fatigue, anorexia, and cachexia, which can be managed with various treatments, including pharmacologic and nonpharmacologic options 4, 5.
Role of Corticosteroids in Palliative Care
- Corticosteroids, such as glucocorticoids, have many uses in palliative care, including managing symptoms of malignancy, nausea, vomiting, depression, fatigue, anorexia, and cachexia 6.
- The use of small doses of corticosteroids, as in the case of the patient, may be beneficial in managing certain symptoms, but it is essential to monitor the patient's response and adjust the treatment as needed.
Current Condition and Treatment
- The patient's current condition, with bloated legs and yellow skin due to high bilirubin, and random word speech, suggests a need for close monitoring and adjustment of treatment to manage symptoms and improve quality of life.
- The patient's low blood pressure (77/57) and pulse (81) require careful attention to ensure that the treatment is not exacerbating these conditions.
- It is crucial to continue providing palliative care, focusing on symptom management and addressing the patient's and family's needs, to improve the quality of life and reduce symptom burden 2, 3, 5.