Causes of Swollen Tongue in Bedridden Patients: A Medical Insight

Tongue swelling

Hello Dr.
Lin: My mother is a long-term bedridden patient.
She has a history of esophageal ulcer (at the gastroesophageal junction), hypertension, and dementia, among other conditions.
Currently, she is being fed through a nasogastric tube.
She started experiencing vomiting two days ago, which contained dark red streaks of blood, followed by episodes of fever that come and go.
Today, I noticed that her tongue is completely swollen.
What could cause the swelling of the tongue? Is it related to oral hygiene? Because my mother has always refused to let anyone clean her teeth.

jan, 30~39 year old female. Ask Date: 2002/06/16

Dr. Lin Mingxing reply Family Medicine

There is a strong suspicion of oral diseases such as ulcers of the tongue or oral mucosa, or inflammation and ulceration of the mucosa in the pharynx and esophagus due to the placement of a nasogastric tube.
Additionally, the recurrence of other gastrointestinal ulcers should not be overlooked.
Recommendations include: (1) consultation with a dentist, (2) interpretation of blood leukocyte counts, (3) referral to a gastroenterologist for reevaluation of the upper gastrointestinal condition, and (4) consideration of respiratory conditions such as aspiration pneumonia, which should also not be ignored.

Reply Date: 2002/06/16

More Info

Swollen tongue, or glossitis, can occur for various reasons, especially in bedridden patients like your mother. Given her medical history, including esophageal ulcers, hypertension, and dementia, there are several potential causes for her swollen tongue that we should consider.

1. Infection: One of the most common causes of a swollen tongue is an infection. This could be a bacterial, viral, or fungal infection. In bedridden patients, oral hygiene can deteriorate, leading to conditions such as oral thrush (a fungal infection) or bacterial infections that can cause inflammation and swelling of the tongue.

2. Dehydration: Patients who are bedridden may not drink enough fluids, leading to dehydration. Dehydration can cause the tissues in the mouth, including the tongue, to swell. This is particularly relevant if your mother has been vomiting, as this can exacerbate dehydration.

3. Allergic Reactions: Allergies to medications, food, or other substances can lead to angioedema, which is swelling of the deeper layers of the skin and can affect the tongue. If your mother has started any new medications or dietary changes, this could be a potential cause.

4. Nutritional Deficiencies: Deficiencies in certain vitamins and minerals, particularly B vitamins (like B12, folate, and riboflavin) and iron, can lead to glossitis. Bedridden patients may have difficulty maintaining a balanced diet, especially if they are reliant on tube feeding.

5. Systemic Conditions: Conditions such as autoimmune diseases, thyroid disorders, or even certain cancers can lead to swelling of the tongue. Given your mother's complex medical history, it's essential to consider these possibilities.

6. Trauma or Irritation: If your mother has been biting her tongue or if there is irritation from the feeding tube, this could also cause localized swelling.
7. Poor Oral Hygiene: As you mentioned, your mother is resistant to having her teeth cleaned. Poor oral hygiene can lead to the buildup of bacteria and plaque, which can cause gum disease and infections that may contribute to tongue swelling.

Given that your mother has experienced vomiting with blood, fever, and now a swollen tongue, it is crucial to seek immediate medical attention. The presence of blood in the vomit is concerning and could indicate a serious underlying issue, such as bleeding from the esophagus or stomach, which may require urgent intervention.

In terms of oral hygiene, it is vital to maintain cleanliness in the mouth, especially for bedridden patients. This can help prevent infections and other complications. If your mother is resistant to traditional tooth brushing, consider using a soft sponge or gauze to gently clean her mouth and tongue.
In summary, the swelling of your mother's tongue could be due to a combination of factors, including infection, dehydration, allergic reactions, nutritional deficiencies, systemic conditions, trauma, and poor oral hygiene. Given her symptoms, particularly the vomiting with blood, it is essential to consult her healthcare provider as soon as possible for a thorough evaluation and appropriate treatment.

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