To think this needs A&E

[paniclife]

My dad is 60 - he has mental health issues and can be quite head strong.

This evening he phoned me and said yesterday that the doctors surgery phoned him and said he needed to go to the surgery immediately, he refused and they insisted, still he refused. So they told him he has alarmingly high potassium levels and they needed to do another blood test to check they were correct. He said he would book an appointment next week.

I asked him why he never phoned me yesterday and I'd have taken him down, he said because he feels fine!!

However, I was with him Thursday and he complained about having diarrhoea for the past three weeks, numbness in his hands and arms and he complained and I witnessed him getting shortness of breath when walking a short distance (not usual for him).

I said I think I should take him to a and e but once again refused and is saying he will book an appointment on Monday! I don't believe him and am now very worried.

Should I make him go to a and e? Is this imminently life threatening? I'm thinking not if he's had diarrhoea for last three weeks meaning he's had high potassium at least since then.

Im just really worried and not sure what to do. Any advice in this?

Unfortunately he wouldn't let me stay, he just wouldn't open the door and I have my kids and am a single mum so there's nowhere for them to sleep there as he has a one bedroom flat. My mum is around but they divorced when I was two. To be honest yes he has form for playing mind games but never something like this but you never know.

Should I call 111 for that rather than 999? He will be so mad but I guess it's my only option however I don't think he would answer to them either. Arrrgh I'm so frustrated. I feel like there's nothing I can do and sick to my stomach about it, but I don't want to think I haven't done enough.

He needs the repeat blood test. Most often, the sample has heamolysed and the potassium is normal, especially if it's reading really, really high. Also diarrhoea or Frances actually secretes potassium, so if anything I would have thought his would be low! He does need the blood test though to confirm if it's a lab error, as hyper and hypo kalemia does need to be treated urgently. If he'll go to A&E they can run a venous blood gas and have the answer in literally less than a minute.

He needs to go to A&E but if he’s refusing then you you make sure he’s not eating potassium rich foods - e.g. potatoes, bananas etc. it might also be that one of his medication may be contributing to it. Would you allow a paramedic in to give him a once over if nothing else? They can do an ecg and see if there are any concerning changes.

This was on the BBC show Ambulance recently, they had been sent to a patient because he'd had a high potassium result on a blood test and the GP couldn't get hold of him. Essentially they'd been sent to take him to hospital, he said he didn't want to go because it was late etc. but eventually they convinced him. They were really reluctant to just leave him to make his own way in his own time.

I don't mean to frighten you but I saw this on an episode of Ambulance. A GP called an ambulance because a blood test came back with alarmingly high levels of potassium for an elderly man and as they couldn't get hold of him after hours of trying, they called 999. Ambulance crew took him to hospital on blue lights

Absolutely not ! And if he says no and had capacity we have zero powers to force him !!

@TrashPanda @ChristmasisRuined
Those programs show you the most extreme cases though.
My dad had a GP appointment and after discussing symptoms, GP wanted him blue lighted to A&E. He reluctantly went there, and it turned out to be nothing.
They always err on the side of caution.

Nonsense. High potassium is a medical emergency. Fact

yes it is a medical emergency, but still doesn’t require an ambulance unless on obviously hugely symptomatic. GPs can request ‘blue lights’ all they want, but we have VERY strict criteria when we’re allowed to use them - ie strokes, severe breathing diffs, major trauma/catostrophic haemorrhage, MIs, cardiac arrests etc (basically only things we’d prealert the hospital for that they’d need teams standing by in resus)

unfortunately the ambulance service is at breaking point and many times it’s due to GPs and 111 (as well as obviously members of public) using us inappropriately

when we attend jobs if the patient has transport and we’re not going provide anything clinically/medically on route we’ll always get them to self convey to free us up to attend other jobs

I didn't call an ambulance or anything, he text saying he was going to bed. Have text him this morning but no reply yet.

@XenoBitch @Bluelightbaby
I didn't advise that OP call an ambulance at all. The show were really clear that an ambulance was called as GP had been unable to make contact so the risk was the patient was already collapsed or whatever. If the patient had spoken to the GP the ambulance wouldn't have been called. I don't know if you've seen the episode but I didn't want to add to worries by saying more.

@paniclife I hope everything is OK with your dad, you managed to get him seen and that a further blood test shows it was just an anomalous result.

I hope he's OK OP.

I come from a family of people who refuse to seek medical help.

My dad was having a stroke and was insistent that he just needed a cup of tea and to walk it off.

My mum had felt weak and exhausted for a month, refused to have it investigated. Eventually she started to struggle to breathe and finally agreed to see a doctor who sent her straight to hospital. She was diagnosed with leukaemia and was dead 10 days later. She was 67 and had been healthy until then. Her body was her business I guess but she might have had a different outcome if she didn't ignore any worrying symptoms.

Sorry my reply was originally aimed at you, agreeing that it’s a medical emergency (that being said it still depends what the levels are)

but then I hold my hands up as I went on a rant as others had mentioned calling an ambulance

OP I don't know where you are but in our area we also have use of the Advanced Trauma Team for things like this (think it's called Rapid Response Team) - they send an advanced paramedic and an A and E consultant to the house (and have quicker acess to ambulances)... it may be worth looking if they are in your area. They can do loads at home as well without having to take people to hospital. This is London (but unsure if it's all areas)

I'm in Scotland. I just spoke with him, he says that even if he goes to the doctors and the high potassium level is correct, he won't go to hospital or get treatment under any circumstances 😩

I think he's basically fine with the thought of dying

That must be really hard to hear and try to deal with @paniclife .

Does he have a history of refusing or not engaging with treatment ? You also mentioned 'mind' games in a previous post I think, if he isn't going to accept any treatment why has he contacted you on a weekend to let you know all this ? He must know you would be worried ?

He’s being a ridiculous human being but you know that.

I’ve got similar issues with calcium, magnesium and vit d. All things you don’t regularly think about but it turns out the symptom progression is pins and needles > heart attack > death. Mostly it’s fine if I take my pills but there’s been a few times when my prescription got messed up where I’ve run out despite my best efforts (my consultant was deaf to my pleas of “but the chemist need a week to order it in” and kept waiting until last minute to issue it. On a bank holiday).

If you can get things up and rolling a&e isn’t always needed - if I suspect we’re getting into an emergency decision I call Clinical Decisions at the hospital now and they get me in for a test. I take a bucket full of meds but usually that’s all it is - occasionally I’ve needed to stay in for a few hours for an IV and once three nights on an OV when they crashed properly - but ifbpotassium is similar the treatment is really not much to fuss over. The embarrassment of needing to go to hospital for “really bad pins and needles” though 😳 Mumsnet "it's not an emergency unless your leg has dropped off" folk would have a fit.

I doubt he would do that but he could be playing mind games.

I've just been thinking, years ago my dad gave the doctors permission for me to know about his medical stuff like to speak to me about it. Do you think it's worth calling tomorrow and see if they'll tell me anything?

If it’s still noted on his records, they got - but be prepared to ask to speak to the practice manager if you can’t get past the gate keeping receptionists. They may still refuse though, as they may say it needs POA for health matters not just previous patient consent.

If he has capacity, he needs to be allowed to make his own decisions. Yes, it is worrying for you, but all of us would want our choices to be respected.

@paniclife I think the best thing to do is to make the phone call and see what they say, explain you believe you have his consent, it should be flagged somewhere on the computer, to discuss his health/results with them.
Ask them if it could be a bad result , are all his other results from the same test within the normal parameters ? Has he been collecting prescriptions, they won't be able to tell you if he has been taking his medications, it might be worth asking him if he has ?

@Hbh17 Capacity isn't a one off thing though is it ? It is time and decision specific ? We have no idea if OP's Dad has been taking his medications for Bi-polar, we have no idea if his electrolytes are deranged, both of which could be having an impact on his capacity to make a particular decision ?
Absolutely he has the choice to make unwise decisions regarding his health, most of us do that every day when we pick up a biscuit or pour a glass of wine ! But refusing treatment isn't the same as having the capacity to do so, if he had said 'yes I know if I don't have the treatment I might die or suffer adverse effects as a result' then it shows an understanding of the implications of his decision and therefore the capacity to make it ?

Yes . This ^^. Out of hours GP should be able to tell you if the potassium was so high that it needs checking immediately or can wait 24-48 hours. If a blood sample is left in the tube for two long or slow coming out of the needle it can be haemolysed (cells burst) . This gives a spurious high potassium. Quite a common thing to happen but should be double checked.