sophie
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Re: Status hearings discussion thread / next hearing March 16th
lorazepam in connection with diuretics/fluids and bph (prostate enlargement) can lead to enuresis/incontinence according to what i read.
mj had high lorazepam levels. usually, the daily max dose in a not intubated patient would be 4mg. the blood levels indicate mj had been given 7-12mg (acc to ruffalo). a ICU patient who was given high lorazepam doses would usually be intubated and catheterized.
the autopsy report says the bladder contained 550ml. that's a full bladder. in the urine bottle at scene was 450ml. if it was from the same night 1l of urine had been produced. murray had given iv fluids and juice bottles had been found at bedside, so seems mj had been drinking o-juice on top of the iv fluids which murray gave him.
with the high lorazepam dose, the fluids and since mj had bph, it's quite possible mj had developed enuresis, that could be the reason for the condom catheder, to avoid an "accident".
the large amount of urine collected also indicates mj had been sedated for a much longer period of time than murray admits. a usual production rate would be 50ml/h, with the fluids murray gave let's assume a higher rate of 100ml/h, if mj died at noon the urine would still have been collected since at least 7am. urge usually sets in at 250-300ml according to what i read, it should have set in at least at 10am, yet murray claims he gave the propofol bolus at shortly before 11am. why didnt mj empty his bladder before murray sedated him?
i just googled the topic and have seen that here's a mj blog where the topic is discussed as well:
http://gatorgirl277.blogspot.com/2011/03/but-i-have-got-to-pee.html
http://www.lipstickalley.com/blogs/ms-chesapeake/but-i-have-got-pee-1682
s. here for causes of enuresis:
src: http://www.nafc.org/bladder-bowel-health/bedwetting-2/adult-bedwetting/
src: http://www.continence-fdn.ca/pdf/The-Source.pdf
drugs which can cause incontinence:
src: http://www.merckbooks.com/mmha/pdf/table2_excerpt.pdf
One of the things KZ wrote on Trial and tribulations, is that she was surprised at the use of a condom catheter. My understanding of what she said, is that Murray was anticipating a prolonged "deep" sedation.
what do you think of that ? Would it be necessary if Michael was kept asleep with lorazepam or the condom catheter would suggest sedation with an aneasthetic ?
lorazepam in connection with diuretics/fluids and bph (prostate enlargement) can lead to enuresis/incontinence according to what i read.
mj had high lorazepam levels. usually, the daily max dose in a not intubated patient would be 4mg. the blood levels indicate mj had been given 7-12mg (acc to ruffalo). a ICU patient who was given high lorazepam doses would usually be intubated and catheterized.
the autopsy report says the bladder contained 550ml. that's a full bladder. in the urine bottle at scene was 450ml. if it was from the same night 1l of urine had been produced. murray had given iv fluids and juice bottles had been found at bedside, so seems mj had been drinking o-juice on top of the iv fluids which murray gave him.
with the high lorazepam dose, the fluids and since mj had bph, it's quite possible mj had developed enuresis, that could be the reason for the condom catheder, to avoid an "accident".
the large amount of urine collected also indicates mj had been sedated for a much longer period of time than murray admits. a usual production rate would be 50ml/h, with the fluids murray gave let's assume a higher rate of 100ml/h, if mj died at noon the urine would still have been collected since at least 7am. urge usually sets in at 250-300ml according to what i read, it should have set in at least at 10am, yet murray claims he gave the propofol bolus at shortly before 11am. why didnt mj empty his bladder before murray sedated him?
i just googled the topic and have seen that here's a mj blog where the topic is discussed as well:
http://gatorgirl277.blogspot.com/2011/03/but-i-have-got-to-pee.html
http://www.lipstickalley.com/blogs/ms-chesapeake/but-i-have-got-pee-1682
s. here for causes of enuresis:
Some medications have been documented to cause nocturnal enuresis as a side effect including hypnotics or medications taken for insomnia and drugs taken for psychiatric purposes such as thioridazine, clozapine, and risperidone. Obstructive sleep apnea or sleep disorders can cause nocturnal enuresis as well. Be sure to talk to your healthcare provider about any medications prescribed and their side effects. Much research supports the belief that secondary enuresis in adults is usually a serious symptom of an underlying problem that should be investigated. Generally, this type of bedwetting occurs with other symptoms and is often associated with daytime wetting. Adult onset nocturnal enuresis is often a result of problems with the urethra, such as prostatic or primary vesicle neck obstruction. Such problems can be associated with the prostate in men or pelvic organ prolapse in women.
Additional causes of secondary enuresis may also include diabetes, urinary tract infection, urinary tract stones, neurological disorders, anatomical abnormalities, urinary tract calculi, prostate cancer, prostate enlargement, bladder cancer, and obstructive sleep apnea. In very rare cases, acute anxiety or emotional disorder may cause adult bedwetting.
src: http://www.nafc.org/bladder-bowel-health/bedwetting-2/adult-bedwetting/
Nocturnal enuresis is the term used to describe bedwetting in children who are old enough to be toilet-trained and adults who experience loss of bladder control at night.
Causes of temporary incontinence:
- Alcohol, caffeine and other diuretics
- Drinking too much liquid
- Urinary tract/bladder infections
- Bladder irritants like carbonated drinks, citrus fruits and juices and artificial sweeteners
- Medications including sedatives, diuretics, muscle relaxants, antidepressants, blood pressure drugs, heart medications and cold medicines
- Constipation
In men, incontinence is often caused by problems with the prostate.
src: http://www.continence-fdn.ca/pdf/The-Source.pdf
drugs which can cause incontinence:
[...]
Sedatives (diazepam, flurazepam, lorazepam): Can slow mobility and worsen urge incontinence
Diuretics: Increase urination by increasing urine production
src: http://www.merckbooks.com/mmha/pdf/table2_excerpt.pdf