Juvenile-HD

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INDEX Page
Tools For Viewing
10 The Most Commonly Asked Questions
Clinical Trials & Research
Huntington's Disease~WeMove Info
Advocacy/Donations/Press Info
Clinical Definition & Search
Facing HD~Family Handbook
JHD Handbook-Chapter 1
JHD Info-Stanford Univ.
Physician's Guide To HD
Caring for People with HD
Physical & Occupational Therapy In HD
Understanding Behaviour in HD-Dr. Jane Paulsen
Understanding Behavioral-Dr. Edmond Chiu
Advanced Stages Caregivers Handbook
First Shift-Certified Nursing Assistants
Activities of Daily Living-HD
Unified HD Rating Scale (UHDRS) Motor Section
Westphal Variant
SECTION 1 - AT RISK
Age & Probability Chart
At Risk For HD-What Next?
At-Risk Checklist
Best Interest of Child?
Crystal Ball?
Food For Thought
Parent Hasn't Tested?
Q&A On Risk of Inheriting JHD
Testing Children
SECTION 2 - GENETIC TESTING
Genetic Disorders & Birth Defects
Genetic Testing for HD
Genetic Counseling-In General
Psychological Impact
Intro: Genetics/Genetic Testing
Prenatal & Preimplanation
Prenatal Testing-In General
o Genetic Testing Resources
o Personal Stories
SECTION 3 - JHD
Coping With The Early Years
Age of HD Appearance
Age of Onset-Historical
Family-HD Underestimated
Children of Parents With HD
Child~Parent Ill
Clinical Description JHD
HD - What Kids Are Saying
HD & Me
JHD-Duration of Illness
JHD-Clinical and Research
JHD Symptoms
Parenting With HD
Patients/Families Coping
Talking With Children About HD
5 Stages of HD
JHD Resources
SECTION 4 - SYMPTOM RECOGNITION
Parent Resources
8 Fears of A Chronic Illness
Anxiety/Apathy/Irritability~HD
Anxiety, Fears & Phobias
Apathy-Physician's Guide
Ataxia
Attention-Perceptual/Unawareness Physician's Guide
Bed/Pressure Sores
Bed/Pressure Ulcer Guideline
Behavior Management
Bi-Polar Disorders
Botulinum toxin therapy
Bradykinesia
Caring Tips
Child Abuse-Reconizing Signs
Chorea-Physician's Guide
Chorea
Cognitive/Decision Making/Impulsivity
Cognitive-Short Tips
Contractures~Joints Locking
Dehydration-Physician's Guide
Dehydration
Delirium
Denial of HD
Depression~Physician's Guide
Depression-Understanding It
Depression-How To Help
Depression - Treatment Resistant Patient
Depression-Other Resources
-Read If Your Child Is On Antidepressant
Disgust - Impaired Recognition in HD
Dissociative disorders
Driving - Physician's Guide
Dyslexia
Dyslexia Resources
Dystonia
Dystonia/Rigidity & Spasticity Physician's Guide
Dystonia-Predominant Adult-Onset HD
Epileptic Seizures and Epilepsy
Epilepsy-Seizures~PG
-Seizures ~Special Populations
Falling~Safety
Falling - Subdural Hematoma Risk
Fevers - Unexplained
Fevers, sweating & menstural cycles in HD
GERD (Stomach)
HD Principle Treatments
Hallucinations/Psychosis~PGHD
Hand muscle reflexes in HD
Hypothalamus - A Personal Theory
Insomia ~Physician's Guide
Irritability~Temper Outburst Physician's Guide
Learning Disability
Mania/OCD~Physician's Guide
Mood Disorder Rate In HD
Myoclonus (Movements)
Nails-What To Look For
Night Terrors
Obsessive Compulsive OCD
Panic Disorder
Personality disorders
Pneumonia
Pneumonia-Advanced Stages
Pneumonia - Aspirated (Inhaled)
Prosody - Social Impairment
Sexuality~Physician's Guide
Skins Sensitivity
Sleep Disorders
Smoking-Physician's Guide
Spasticity
Stress
Tremors
Why Certain Symptoms Occur
Symptom & Treatment Resources
SECTION 5 - COMMUNICATION
Communication Resources
Communication Problems
Communication Strategies For HD~Jeff Searle
SECTION 6 - EATING/SWALLOWING/NUITRITION
Hints For Weight Loss in HD
HD & Diet~HSA Fact Sheet 7
Nutrients: Some Possible Deficiency Symptoms
Nutrition and HD~Anna Gaba (Recipes)
Nutrition Information In HD~Naomi Lundeen
Speech & Swallowing~Lynn Rhodes
Swallowing & Nutrition Physician's Guide To HD
Swallowing & Nuitrition Resources
Swallowing Warning Signs
5 Swallowing Problems
Taste changes in HD
Weight Gain
Resources-Drinks/Shakes
-Feeding Tubes~Advanced Stages of HD
-Feeding Tube~Jean Miller
-Feeding Tubes: One More Word ~Jean Miller
-Feeding Tubes & Baby Foods
-Feeding Tube~Dental Care
-Feeding Tube Instructions~Jean Miller
-Feeding Tube Resources
SECTION 7 - THERAPIES
Finding a Therapist - Behavoir
What Is A Physiotherapist?
Physical Therapy In HD
Speech-Language Therapy
Therapy Descriptions
Therapy Resources- Easter Seal
Therapy Resources
SECTION 8 - MEDICATIONS
HD Treatments
Medications-Movement Disorders
Medication/Emergency Info Forms
Cutting Prescriptions
Drugs-Look 'Em Up
-Adolescents Under 25
-Antidepressant Adverse Effects
-Anti-psychotic
-Anxiety-Antidepressant
A-Z Mental Health Drugs
-Creatine
-EPA~Fish Oil
-Haldol/Haloperidol - Clinical Sheet
-Haldol~Clinician Description
-Haldol & HD
-Haldol/HD Patient Experiences
-Haldol~ Patient Handout
-Mood Stabilizers: ASK 3 Questions
-Neuroleptic Malignant Synd WARNING
-Olanzipine-Risperidone/blood tests
-Celexa/Luvox/Paxil/Prozac/Zoloft
-Psychiatric Drugs & Children
Sertraline ~Zoloft
-Spasticity Meds/Treatments
-SSRI Medications
-Tardive Dyskinesia WARNING
-Weight Gain Medications
-Sites/Help the Medicine Go Down
-Vitamin & Mineral Deficiencies
SECTION 9 - SURGERIES
Surgery-Movement Disorders
o Surgery Resources
SECTION 10 - PROCEDURES
Clinic Visits-How To Prepare
CT Scans, MRI's etc.
Swallowing Tests
Tests Commonly Used
o Procedures Resources
SECTION 11- ALCOHOL/DRUGS
Alcohol-Parent's Guide
Alcohol-Talking To Your Child
Drugs-What To Do?
Drugs-Talking To Your Child
Disciplining-Ages 0-13 & Up
SECTION 12- SUICIDE
Straight Talk On Suicide
Teen Suicide-You Need To Know
o Suicide Resources
SECTION 13 - DIVORCE
Divorce & Child Stress
Tips For Divorcing Parents
SECTION 14 - DISABILITY ISSUES
Guides To Disability Issues
Caring-Child & Medical Technology
Caring for a Seriously Ill Child
Child Long Term Illness
Disability-Special Education Plan
IFSP Early Intervention Process
Disability Resources
Financial Planning
Wishes Can Come True-Children's Wish Foundations
Special Needs Resources
Special Needs Camp - About
Special Needs Camp - Finding One
SECTION 15 - ASSISTIVE TECHNOLOGY
Child Assistive Technology
Adaptive Equipment Resources
Products
SECTION 16 - EMOTIONAL ISSUES
Signs of Unhealthy Self-Esteem
Emotional Behavior Links
o Emotional Support Resources
SECTION 17 - GRIEF
Helping Child Deal With Death
o Grief Addtional Resources
SECTION 18 - ADD/ADHD
ADD & Teens
Conduct Disorders
FAQS & Related Info
Understanding AD/HD
What Is AD/HD?
Research Articles
Resources
SECTION 19 - HD SUPPORT GROUPS
HD Support Groups
National Youth Association
SECTION 20 - HD LINKS
HD Links
Related Resources
Tips For Friends
SECTION 21 - BENEFITS/INSURNACE
HD Disability
Benefits Check UP - See What You Can Get
Medical Insurance Bureau's Facts On You!
Medicare-Medicaid
Medicare Rights-Home Health & Hospice
Medicare Rights Center Resources
No Insurance? Try This!
Prescription Drug Cards Part I
Prescription Drug Cards Part II
Social Security-Children With Disabilities
SECTION 22 - ARTICLES/JHD
JHD and ADD
SECTION 23 - CAREGIVING
Articles-Resources
Caregiver Self-Assessment
Caregiver's Handbook
"First Shift With A Person With HD"
Getting Respite Care/Help At Home
Helpful Forms-Info
Home Emergency Preparations
Symptom Management
Ten Tips
Useful Tools
SECTION 24 - BIO
Our Personal Experience
Coping At The End
Kelly E. Miller
Song & Verse
Letter From My Heart
GUESTBOOK
Dehydration-Physician's Guide

INDEX Page

Dehydration
 
The Physician's Guide to HD Management states, under Delirium:

Delirium, an abnormal change in a patient's level of consciousness, may result from a variety of toxic, structural or metabolic causes. Delirious patients may have waxing and waning of consciousness, may be agitated or lethargic, and frequently have disturbed sleep. Patients in the later stages of HD, are particularly vulnerable to delirium.

Common causes of delirium in HD include prescription medications, particularly benzodiazepines and anticholinergic agents, alcohol or illicit drugs, and medical problems such as dehydration and respiratory or urinary tract infections.

It is important to ask about over the counter medicines such as cold tablets and sleep aids, which patients and families may forget to mention. Subdural hematoma, due to a recognized or unrecognized fall should also be considered if the patient suffers a sudden change in mental status.

Delirium can also come about gradually as an underlying problem worsens. For example, a dehydrated patient may no longer be able to tolerate his usual medication regimen. Delirium can also be mistaken for a number of other conditions in HD.  As mentioned previously, it may be accompanied  by hallucinations or paranoia.
 
Clinicians usually expect delirious patients to exhibit agitation or hyperarousal and may overlook the delirious patient who is somnolent
or obtunded. Such patients may seem depressed to their families, but when questioned will not report a low mood.

Physicians should consider a diagnosis of delirium whenever confronted with an acute behavioral change in someone with HD and should review the medication list, examine the patient, and obtain necessary laboratory studies, including a toxicology screen if indicated.   Identification and
correction of the underlying cause is the definitive treatment for delirium.

~~~~~~~~~~~~~

Dehydration
  • As dehydration progresses, the tissues tend to shrink, the skin becomes dry and wrinkled, and the eyes become shrunken and the eyeballs soft.
  • Fever develops, which may be mild but may become marked as dehydration progresses. Dehydration itself probably affects the temperature regulatory centres in the brain.
  • As dehydration and salt loss progress, however, the plasma volume and the output of the heart decrease, with consequent decrease of the blood supply to the skin.
  • Sweating decreases and may stop completely, and the main avenue for heat loss is closed. The body temperature may then rise precipitously.
  • Dehydration becomes rapidly worse, and death may ensue within two or three days.
  • Water is lost from the body by evaporation from the lungs and skin, through the urine, and through the stools, a loss that can become serious in diarrhea.
  • Lung and skin losses are increased by work that causes sweating, particularly in a hot, dry climate. The kidneys usually excrete between one and two litres of urine per day, but when dehydration threatens they can conserve water through concentration of the urine.
  • The most severe dehydration occurs from diarrhea, with or without vomiting.
  • The most efficient lifesaving treatment is intravenous infusion of sterile water containing glucose, sodium chloride, and potassium chloride.
  • When swallowing is difficult in extremely ill persons, or when people cannot respond to a sense of thirst because of age or illness or dulling of consciousness, the failure to compensate for the daily loss of body water will rapidly result in dehydration and its consequences.

Water is poorly absorbed when drunk, but a good first aid formula consists of sodium chloride, 3.5 grams; sodium bicarbonate, 2.5 grams; potassium chloride, 1.5 grams; glucose 20 grams (or sucrose 40 grams); and clean water up to one litre. The glucose assists absorption of the sodium and vice versa, and as they are absorbed water is absorbed with them.

Fever and dehyration

Avitaminosis
(vitamin lack) may be encountered when there are increased losses of vitamins such as occur with chronic severe diarrhea or excessive sweating or when there are increased requirements for vitamins during periods of rapid growth, especially during childhood and pregnancy.

Fever and the endocrine disorder hyperthyroidism are two additional examples of conditions that require higher than the usual levels of vitamin intake. Unless the diet is adjusted to the increased requirements, deficiencies may develop.

Lastly, artificial manipulation of the body and its natural metabolic pathways, as by certain surgical procedures or the administration of various drugs, can lead to avitaminoses. (Diseases involving deficiencies of particular vitamins are discussed in nutrition: Deficiency diseases:
Vitamins.)

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Nutritional Support & Hydration

People who are physically unable to swallow, digest, or absorb food and fluids taken by mouth are at obvious risk of malnutrition and dehydration.
 
Without nutritional support and hydration, such individuals will become increasingly weakened. As their immune system function is reduced, they may die from infections before death can occur from malnutrition or dehydration.

Malnutrition is caused by inadequate intake of calories, protein, carbohydrates, fats, vitamins, minerals, trace elements, or any combination. The effects of malnutrition depend on its severity, duration, and which specific nutrients are lacking.
 
The effects include: weight loss, listlessness, and depression; decreased ability to resist infection, to recover from illness, and to withstand surgery or other treatments; impaired wound healing; decreased cardiac and respiratory muscular strength, confusion, coma, and eventual death.

Dehydration is the loss of body water in excess of intake. It is caused by decreasing fluid intake or inability to conserve fluids as a result, for example, of renal disease or severe diarrhea.
 
Dehydration results in dry mucous membranes; decreased sweat,
saliva, and tears; muscle weakness, rigidity, or tremors; confusion, hallucinations, and delirium; abnormal respiration; coma; and eventual death.
Tube Feeding Techniques and Intravenous Feeding Techniques

The different views about withholding or withdrawing nutritional support and hydration remains a difficult dilemma with important clinical, legal, ethical, financial, and political aspects.

Is withdrawing nutritional support and hydration from a terminally ill or severely debilitated person killing them or merely allowing them to die?

Is the suffering caused by malnutrition, starvation, and dehyration acceptable to the patient?

Is the suffering associated with the aspects of tube or intravenous feeding procedures acceptable?

Since the procedures are covered by Medicare and Medicaid for many patients, is the increased use proper use of limited public funds?

Then, the difficulty of determining which patients are terminally ill adds to this life or death decision.

Source: 
http://seniors-site.com/ultimate/nutritio.html