Concerned about advice to stop diuretics and diabetes medication

[Dymaxion]

Really concerned about advice relative has been given re 'sick day rules' . GP was supposed to visit today but ANP came instead. DH has worsening heart failure symptoms, primarily lower limb oedema/fatigue and reduced mobility. He has also been experiencing diaorhhea for a few months so requested a FIT test. ANP has taken bloods and left FIT test. They have also advised him to stop all his diuretics and his diabetes meds. He has been eating and drinking normally and hasn't been 'unwell' as in D&V, just chronic diaorhhea. Just worried that stopping the diuretics is going to exacerbate the heart failure symptoms even more and he is going to end up needing admission to hospital, which he has so far managed to avoid for the past 6 years.

I have the same sick day rules for heart failure. It’s a standard thing. If you have diarrhea, you lose more water quickly and your blood pressure tanks dangerously.

Falls from dizziness can be very dangerous, so stopping the diuretic keeps your bp up to safe levels and stops you fainting and falling.

Heart medication is very hard on our kidneys too and diuretics with diarrhea can increase the salts in your blood, which further impacts your kidneys, so there are good reasons for this protocol.

@Sminty2 I understand what you are saying and it makes total sense, but he already has a lot of fluid building up in his legs , they have doubled in size and are leaking and blistering and that's with taking furosemide and spironolactone. That was the main reason for calling the GP.
He has been told to stop his meds and wait until the diarrhea resolves, but it has been going on for months, he has had a diagnosis of diverticular disease and we asked for the fit test due to family history, it hasn't been caused by a bug.
Just worried that if he follows the advice and stops the meds and waits for the chronic diarrhea to resolve he is going to end up in hospital or worse.

I completely understand why you’re so worried.

I would take him to A & E and ask for his legs to be looked at and properly dressed. Don’t let them put you off, risk of infection is serious.

GPs are not always right about Hf, it’s a specialty.

If he is on Metformin for diabetes, we were told it can cause diarrhoea so that might be why they told him to stop that one.

It's not the GP in this case..the ANP has decided he's got an acute diarrhoea illness and in that situation yes you stop the diuretics but the diarrhoea seems to be chronic in this case in which case there is no apparent clinical reason to stop them. He needs a GP review. But yes HF is a complex illness to manage and if his legs are swelling so quickly he needs urgent assessment

I'd agree with trialling time off this drug. It can be awful for causing loose bowels.
How much furosemide was he on? They stopped my fil's diuretics as his kidney function had deteriorated slightly but didn't start them again when he left hospital. His kidney function wasn't that bad and it was a balancing act anyway bad kidneys Vs fluid overload and at 97 symptom control was the important thing.

has he been drinking diet or (allegedly) full fat fizzy drinks that secretly contain artificial sweeteners? check the ingredients. those things are horrific on bowel flora.

thats what set me off with the runs for months as i thought i didn't have any issues with sweeteners but something changed and i did. Then i moved to full fat pepsi. and the runs started again, in tiny writing on the back it said thw full fat version contains sweeteners. disgraceful to hide that the way they did. they aught to be ashamed. im on full fat coke now. it’s ok.

i would phone the practice again and tell them about his legs swelling and leaking and ask to see the gp this time as a matter of urgency as his legs are gettimg worse.

If no appointments you might have to ring nhs24 later.

i would not just rock up at A&E until i had tried both these avenues.

he needs to keep his legs elevated when sitting and take exercise if he can. no standing stock still, march or rock.

He has been on metformin for 6 yrs so doubt its that. He doesn't drink diet drinks , just water and the occasional cup of tea.
The practice know his legs are swelling and leaking, I put that in the triage form. He is getting a home visit next week, his bloods were all okish, no sign of acute kidney injury or anything like that so has been advised to ignore initial advice and continue on meds.

that seems like sensible advice.

do you know which metformin he is on? you can get slow release metformin which my friend switched to when she got the trots like your dh - after about four years of regular metformin.

maybe he needs to switch to that. it totally fixed her.

ps what do you use at night to protect the bed for the leaking legs? i have a relative with similar issues and we put puppy pad type dressings round her legs with stockinette over them.

tried covering the fitted sheets but she just kicks off folded bedsheets or big towels and the sheets cannot be washed nightly hence the legs get covered now but she hates it.