FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

PNEUMONIA CAN STRIKE QUICKLY AND WITHOUT WARNING IN ELDERLY

Question: My mother was recently rushed to the hospital with pneumonia. Her temperature was over 104, her pulse rate was 180, her blood pressure was very low, and her magnesium level was almost zero. In addition to the pneumonia, she was diagnosed with a blood infection. This all came on very suddenly. Is it common for pneumonia to be an emergency condition like this, almost like a heart attack?

Answer: As you probably know, pneumonia is an infection that involves the lungs. There are at least 4 million individuals with what we doctors call "community acquired pneumonia" every year. This cumbersome name is used to identify infections contracted outside the hospital (i.e., in "the community") from those that are acquired during hospitalization for another illness. This distinction is important because hospital acquired infections tend to be more serious.

I don't intend to imply that community acquired pneumonia isn't serious. Of the 4 million who come down with this disease each year, about 800,000, representing all age groups, need hospitalization as your mother did. Those who are in their first year of life or those over 65 are at greatest risk from the infection, however. Members of these age groups who are hospitalized have a 13 to 25 percent risk of death from pneumonia. Those who have underlying heart problems, lung conditions, kidney failure, diabetes or other serious conditions have even worse risks. This is a serious illness!

Your mother's illness came on suddenly, as often occurs in pneumonia. Fever, shortness of breath, a fast breathing rate, general body aches, and cough are often present. Unfortunately, these symptoms may be very mild or even absent in the elderly, particularly when the pneumonia occurs suddenly. Often the person only complains of being weak.

Elevated fever, pulse rate, breathing rate and low blood pressure are signs of a very serious infection. Prompt hospitalization for intravenous antibiotics, oxygen, perhaps utilizing a ventilator to assist breathing, and other medications are necessary, and in your mother's case, saved her life. The "infection in the blood" you reported is not unusual in this type of overwhelming pneumonia. The organism in the blood is the same one causing the pneumonia, and its presence in the blood is a consequence of the overwhelming nature of the infection.

Magnesium is a salt in the blood that must be present and in balance with sodium, calcium and others. Your mother's low magnesium level occurred as part of the complex biochemical response to the overwhelming infection and ensuing cardiovascular system collapse. This abnormality is a sign that her illness was quite serious. Obviously, she received prompt high quality care because she recovered from this illness.

There are many types of bacterial and viral infections that cause pneumonia. Pneumococal pneumonia is one type that often strikes rapidly and may become fatal without prompt treatment. Fortunately, there is an immunization that provides protection against the most common strains of this disease. If you are over 65 or have a chronic condition such as diabetes, heart disease, kidney disease, or lung problems, be sure to see your doctor for this immunization.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.