I had a fit last night

[Ihadafit]

Just need some hand-holding and impressions.

My DP was woken up last night by me "having a fit" - me eyes were open and vacant, I was completely unresponsive and shaking violently.

I hope this isn't epilepsy etc. Thankfully I already have a GP appointment booked for this afternoon.

Really, really, scared...

Bioavailability of oral morphine is around 23%, compared to 100% for IV, however I'm assuming your IV dose was much smaller. So the HCP who told you the bioavailability of oral/IV morphine is the same is talking out of their bottom!

Morphine can make gallbladder spasms worse - really, really to be used with caution .You should be offered an antiiflammatory + Paracetamol + codeine in the first instance.

Codeine is metabolised into morphine in the body. Your post does not make sense.

Yes, I know how codeine gets metabolised.
Opiates in general are not without risk in gallbladder disease - whatever the cause.
Hence NSAID, then Paracetamol, then a less potent, then morphine.

I don't think that it is at all clear what is going on here and it is of course impossible to give specific advice with the information available.

"Codeine is metabolised into morphine in the body. Your post does not make sense."

Well, yes, but it's a fair bit more complicated than that. It's not a straight swap into morphine - only 0-15% of codeine metabolises to morphine and morphine has a 200x affinity for mu opioid receptor (OPRM1), which is the key receptor for addiction. Codeine is metabolised by the liver, the intestines and the brain, using different pathways.

So, as you'd expect of PacificDogwood, her post made perfect sense. As did her explanation of the increased risk of surgery on an inflamed gallbladder.

Moral of story.
Do not mention bioavailability to your patients.

As a detox nurse I'm only aware of that all too well. My comment was made in reference to morphine being a bad choice in these circumstances. As you know, very low dose morphine is barely stronger than high dose codeine. And codeine still metabolises into some morphine. Morphine = bad but codeine = ok? Why? Is it the dose of morphine that's problematic or it's presence? I'm asking out of curiosity as I don't deal with gallbladder issues. I'll stop hijacking the post after this comment.

So it's got nothing to do with the pancreas and all to do with addiction?

No, sorry, myoriginal, I was just pointing out that it is different.

FruitCider, morphine can increase the tone in the sphincter of Oddi (hepatopancreatic sphincter) which is the muscle around the common bile duct and the pancreatic duct. While codeine metabolises into morphine, the fact that it does so at only a rate of 0-15% presumably means that the effect would be weaker?

I'm lost. not an unusual place for me to be

Completely agree with Lougle. Whatever's going on it all does sound rather strange. Whatever the underlying cause of OP's symptoms I hope she's getting the treatment she needs.

Well she's clearly not getting any treatment!

Agree lougle, I'm focusing on poor pain management, but using the IV morphine to detail pain severity and how it was the only thing to help.

They gave me paracetamol, that's it. And two doses of Oramorph.

I did have an ultrasound, showed stones but little inflammation, surgeon thinks it's at the tail end, but a decent chance of reoccurrence.

Pain is still very high, but at least I have my usual painkillers at home.

My BP was elevated, hardly a surprise.

Pacific - the initial A&E doctor said to avoid NSAIDS. Due to lack of appetite and vomiting I'm thinking?

Am pushing the inconsistency in communications, and poor pain management in my PALS letter.

Thanks for all the posts, you've really helped this past couple of days.

If I do have reoccurrence I shall push for gallbladder removal though, fuck going through this multiple times.

Interesting reading .I agree ,hard to know exactly what's going on .Though one would guess that lack of continuity ,numerous people /HP involved must complicate things .

On a much minor subject - I had my EEG yesterday .Lovely technician - cannot imagine how hard it must be to deal with children and stressed parents . All ok - found lights a bit hard to cope with ,especially the low frequency ones .Given melatonin ( technician thought it would be something else and didn't know why changed ) which I found problematical .Seemed to hit after the procedure ( and made me feel quite ill ) so didn't manage to fall asleep ( and I'd been awake since 4 am ) .Which I'm sorry about .Apparently the brain activity is different when asleep and can show a propensity for epilepsy .

Gum used on head for electrodes was water soluble so washed out .

Anyway - for Ihad ,I know it's a cliche but top tip for any complaint is first work out what you want - apology /explanation/review of protocols ?

Let us know how you get on .

How are you doing now?

Just read this post, you had a CT Scan, usually during a CT Scan they can find gall stones, plus give an accurate indication of size.

Your location is also interesting.

You don't appear to have been informed of the diet that goes with gall stones. You also didn't appear to receive any anti emetics even though vomiting. Usually paracetamol is given IV as it works better, so to be given oral pain relief seems to be really odd if you're vomiting.

I'm guessing OP hasn't been back?