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This is Dr. Daviud
I think I helped you before.
I am so sorry about your husband.
I know you are still not over his passing.
Nitrofurantoin can cause respiratory distress and pneumonitis and pulmonary fibrosis in rare cases.
you can read more here
a CT scan of his lungs and a bronchoscopy and biopsy of his lungs could have detected any pulmonary fibrosis if it was there.
an autopsy as well could have checked for pulmonary fibrosis.
but he didn't have an autopsy, correct.
Thank you for that. You are right, there was no autopsy. Looking at the packaging, long term nitrofurantoin use needs to be monitored and any instances of lung problems reviewed closely. Not, as was his case, to have the medication continued intravenously even when he was in ICU. He did have several chest xrays in there and an examination using a camera. Would the camera have disclosed anything? All they said was that this "was clear". I will read the lim
Sorry, link you supplied. would you mind if I come back to you once this is dealt with?
did the camera test go into his lungs with bronchoscopy.
a bronchoscopy and biopsy of the lung tissue could tell if there was pulmonary fibrosis.
I would get copies of his scope procedures
I would be happy to review them with you.
My main question is this. Given the fact that he was taking nitrofurantoin, was not being monitored for this, had all the symptoms of NILD etc, should this have been considered early on? I understand that it is possibly rare but it IS mentioned that people taking this for over 6 months need to be monitored and a decision made about whether the advantages outweigh the risks involved.
You are correct, I am obviously not reconciled to his death in this way. However I am pretty cool - headed about it but want to be sure I DO follow things up if, as I suspect, he was treated incorrectly.
his doctors will say they did a chest xray and listened to his lungs to monitor for nutrifurantoin interstitial lung disease
did they perform a bronchoscopy for him?
NILD is a very rare adverse effect of nitrofurantoin.
it should have been considered since he was so sort of breath.
but a visiting doctor has limited testing tools he can use when they do house visits.
he would have needed more sophisticated testing at the hospital to know if he had interstitial lung disease from nitrofurantoin.
one study (1966-1976) mortality among 398 patients with acute nitrofurantoin-associated pulmonary toxicity was only 0.5%. In the same study, the mortality associated with chronic pulmonary toxicity among 49 patients was higher (8%)
2. Holmberg L, Boman G. Pulmonary reactions to nitrofurantoin. 447 cases reported to the Swedish Adverse Drug Reaction Committee 1966-1976. Eur J Respir Dis 1981; 62:180-189. 3. Jick SS, Jick H, Walker AM, Hunter JR. Hospitalization for pulmonary reactions following nitrofurantoin use. Chest 1989; 96: 512-515 4. Sovojiarvi AR, Lemola M, Stenius B, Idanpaan-Heikkila. Nitrofurantoin induced acute, subacute and chronic pulmonary reactions. Scand J Respir Dis 1977;58: 41-50
NILD is diagnosed by a chest CT scan or a bronoscopy and lung biopsy
Thanks for all this. I will obtain the hospital information and speak to you again. Thank you for your help.
May I ask one further question on this please? i have now heard from the hospital and they say he was too ill for a broncoscopy (although I distinctly remember them telling me they had used a camera to check his lungs) and also he had 8 normal xrays. When you mentioned that CT xrays are used to identify NILD did you mean cardio thoracic xrays or computerised tomography xrays please? At the moment they are denying that continuing with the nitrofurantoin would have created a problem' although they apparently didn't check. The doctor is also denying that they had any need to stop the drug or monitor for it's effects previously. If you need me to put this question "through the system" again, would youplease let me know? Thanks