Low Blood Oxygen Levels in Advanced Parkinson's Patients

Decreased blood oxygen saturation?

Dear Dr.
Liang,
My mother-in-law, who is 71 years old and in the late stages of Parkinson's disease, has been bedridden.
On February 19, she experienced a high fever of 40 degrees Celsius due to a ureteral stone obstruction and was hospitalized for a week.
During her hospitalization, she suddenly developed shortness of breath and produced thick phlegm, which improved after suctioning.
The doctor performed a chest X-ray, and the report indicated no significant issues.
However, she has been experiencing a cycle of shortness of breath and suctioning, and her blood oxygen levels have become unstable, ranging between 88% and 93%.
This is concerning because prior to the infection, she had no phlegm or shortness of breath, and her oxygen levels were relatively good.
After a week of hospitalization, she was discharged, but one day her oxygen levels dropped to 67%.
When measured on the other hand, it was the same.
Within a few seconds, her oxygen levels rose to 86%, and after we used the pulse oximeter to provide her with oxygen, it quickly increased to 98%.

I would like to ask Dr.
Liang if this situation requires a return to the hospital for further examination, or if it is sufficient to maintain her oxygen levels at 95% with the oxygen machine without needing a follow-up visit.
Why do I feel that her bodily functions have declined further due to this bacterial infection, with symptoms that were rarely seen before now surfacing?
Thank you for your advice and response.

Miss Wang, 30~39 year old female. Ask Date: 2024/02/28

Dr. Liang Yinpan reply Geriatrics

Dear Ms.
Wang,
Your mother-in-law is in the late stages of Parkinson's disease and is bedridden.
Her physical condition is already weak, and this recent infection has further deteriorated her health.
Her ability to expectorate has decreased, and the accumulation of secretions in the respiratory tract has led to a drop in blood oxygen levels, causing shortness of breath.
Providing supplemental oxygen and suctioning can help improve her condition.

In terms of care, it is important to alternate her position to facilitate drainage, elevate her upper body, and ensure she receives adequate hydration and nutrition.
If, after administering oxygen and suctioning, her blood oxygen levels remain below 92%, she should be taken to the hospital.
Best regards,
Department of Geriatrics, Changhua Hospital
Dr.
Liang Yin-Pan
February 29, 2024

Reply Date: 2024/02/28

More Info

Low blood oxygen levels, or hypoxemia, can be particularly concerning in patients with advanced Parkinson's disease, especially when compounded by other health issues such as infections or respiratory complications. In your grandmother's case, her recent urinary tract infection and subsequent hospitalization have likely exacerbated her existing condition, leading to a decline in her overall health and respiratory function.

Understanding the Causes of Low Blood Oxygen Levels
In advanced Parkinson's disease, patients often experience a decline in muscle strength and coordination, which can affect their ability to cough effectively. This is critical because a strong cough is necessary to clear mucus from the airways. When mucus accumulates, it can obstruct airflow and lead to respiratory distress, which may explain the sudden onset of wheezing and the production of phlegm you described. The infection likely worsened her respiratory status, leading to the observed fluctuations in blood oxygen levels.

Additionally, the fever and systemic infection can increase metabolic demand, which may further strain an already compromised respiratory system. The fact that her blood oxygen levels dropped to 67% is alarming and indicates a significant respiratory compromise. However, the rapid improvement to 98% with supplemental oxygen suggests that her lungs may still have some capacity to oxygenate blood when given adequate support.

Management and Recommendations
Given the complexity of her situation, it is essential to monitor her closely. Here are some recommendations based on her current condition:
1. Continuous Monitoring: It is crucial to keep monitoring her blood oxygen levels regularly. If her oxygen saturation consistently falls below 92% despite supplemental oxygen, it would be advisable to seek medical attention.
2. Use of Supplemental Oxygen: If her oxygen levels stabilize at 95% or above with supplemental oxygen, it may be acceptable to continue using it as needed. However, if she experiences any episodes of significant desaturation (e.g., below 90%), it would warrant a return to the hospital for further evaluation.

3. Hydration and Nutrition: Ensure she is well-hydrated and receiving adequate nutrition. This can help thin mucus secretions, making them easier to clear.
4. Positioning: Encourage her to sit up as much as possible, as this can help improve lung expansion and facilitate better breathing.
5. Pulmonary Hygiene: Techniques such as chest physiotherapy or postural drainage may help in clearing secretions. If she is unable to cough effectively, consider discussing with her healthcare provider about suctioning or other methods to assist in mucus clearance.

6. Follow-Up Care: It is essential to have a follow-up appointment with her healthcare provider to reassess her respiratory status and overall health. If her condition continues to decline or if new symptoms arise, returning to the hospital may be necessary.

Conclusion
In summary, your grandmother's situation is complex, and while the use of supplemental oxygen can help manage her low blood oxygen levels, it is crucial to monitor her closely for any changes. The decline in her health following the infection is not uncommon in advanced Parkinson's patients, as their bodies may struggle to cope with additional stressors. Regular communication with her healthcare team will be vital in ensuring she receives the appropriate care and support during this challenging time.

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