32- Dysphagia-Unable to Eat

• This is always a vital problem because we have only a few injectable drugs.
• If cachectic (xxx001) (xxx005)+ unconscious, best not to do anything.
• Nasogastric feeding tubes would be a solution, but only in wards with enough workers/logistical resources.

No appetite and/or psychological failure:

Prednisolone PO 1-2 pills early in morning during a few days.  But if severe, go on for dexamethasone IM 1cc inj mornings for 1-4 days.  See "9-Dexa" & see "27-Psycho"

Stevens Johnson/erythema multiforme versus Herpetic stomatitis:

See "6-Allergy"

Candidiasis (bxx004) (bxx005) (bxx006) (bxx007) (bxx024)

Nystatin liquid can save a life…  See protocol "7-Mouth"

Aphthous & Herpetic ulcers

(bxx026)  (bxx022)  (bxx025)  (bxx001)  (bxx003)

See protocol "7-Mouth"

Vomiting-nausea

(See 33-Vomiting)

Unconscious, but still physically "strong"

Our experiences teaches us that a last resort can be a high dose of dexamethasone IM (4cc in morning + 2cc at noon), but if no response by second day, we cannot do anything unless injectable curative care with ampicillin (IM/IV) and/or gentamycin is indicated (e.g. meningitis, pneumonia, septicemia, generalized skin allergy with secondary infection, etc.)  If high dose dexamethasone is effective, use the opportunity to give directly the curative treatment (Bactrim for PCP, sulfa-dara for TOXO…) because dexa's effect will be short-lived.  Even if patient is still strong, there is nothing to do if we know patient has HIV dementia or other severe irreversible brain damage.

Coma "1", stroke or other neuro damages, cataclysmic dyspnea, or other unknown causes of severe dysphagia...

See supra: "Unconscious, but still physically strong"...