Medical Question: third Spacing

Anyone here have or intimately know someone who has extensive medical knowledge?

My wife has her masters in nursing but we can't find much information on third spacing in her books and her professional experience with it is limited to "end of life" occurances. The Primary Care Physician only knows what it is and couldn't answer when I asked if it was specific to "end of life" or not.

I'm trying to find if Third Spacing is specific to "End of Life" only or if there have been instances that have been reversed.

I've googled several different phrasings about third spacing and third spacing in general but can't come up with much on the internet either.

My FIL has been Third Spacing for a few weeks now and it's gradually getting worse. His right side is considerably worse than the left. His atrial chambers are enlarged and have been at least since August. His breathing his increasingly shallow though is lungs are clear. His midsection is distending. All the classical symtoms and complications from third spacing are there.

We're trying high protein ensure/boost to see if this gives his cardio-vascular system enough proteins to stop the loss of fluids into the surrounding tissue. The primary care physician is non-commital as to what will help and just keeps saying "this happens in old age". I'm just looking for something we can do to help him improve if possible and I'm tired of doctors who stop caring about patients once they pass a certain age.

For those of you who do, please pray. I fear he's coming to the end of his time on earth with us and I don't know what I'm going to do if this happens. My poor family has been through the ringer these past 6 years and we still haven't seen a light at the end of the tunnel yet. My FIL has been a strong supporting part of our lives through it all and now it looks as if we're losing him too.

Thanks for any knowledge anyone can provide.

Glen F

Glen,

I know a couple of doctors over here in Oz. I'll ask them and let you know, but I guess they're too far away to be much help. But they might be able to point you in the way of some useful information which could perhaps ease your mind

I'm very sorry to hear about your father in law. My thoughts are with you, mate.

James.

Hi there. I’m going to be graduating from med school in May. This means that I won’t have a license to practice until then but I can still tell you what I know about Third Spacing.

Without getting too much into the medical jargon, Third Spacing is when the fluid from the circulating blood seeps into the body’s tissues. By tissues, I mean it can be any of the body’s tissues but it is most often the peritoneal cavity or the intestines. Third spacing happens in patients who are suffering from an extreme illness or trauma. It is common is patients who have just had major surgery.

I’ve only had to deal with Third Spacing in post-op surgical patients. Because third Spacing takes away fluid from the circulating blood and moves it into the tissues, it causes problems related to low blood volume (important organs not being perfused with blood, and electrolyte disturbances).

In general, third spacing is dealt with by correction of the *underlying* illness or disturbance that is causing it (you generally don’t actually treat the third spacing itself). By giving the patient more fluids and correcting the electrolyte and protein imbalances, you are only correcting the symptoms in the short term. In the example of a surgical patient, the third spacing goes away on its own. In the example of a patient with sepsis, when you aggressively treat the source of infection, the third spacing will gradually resolve.

All this to say: without knowing all the rest of you FIL’s problems it’s difficult to recommend any specific course of action. It may well be that the problem that is causing the third spacing is not a clear cut one. Your focus seems to be on the third spacing, but it’s not clear to me what’s potentially causing it.

He did have the arterio-bypass on his left leg. Perhaps this is where it's coming from then. My wife worked as a critical care/surgical nurse for several years in the military but she never came across this. Perhaps it's because all the patients were usually under 40.

Thanks for the information. I hope it helps us determine a path to take. I'm not ready for him to go. Unfortunately he's got multiple problems, diabetes, congestive heart failure, wound complications from the arterio-bypass and a right leg that needs a bypass as well.

Now he's starting to suffer from dementia and we can't tell how much is from the meds they've put him on and how much is from the stress of his problems.

Glen F

Hi Glen,

I am a general practitioner. Third spacing is not something we see a lot in primary care.
Reading through what you wrote I just wonder whether heart failure isn't part of the problem. When you say thrid spacing do you mean oedema?

I fluid is leaking into the tissues this is most commonly due to either heart or renal failure or the intravascualar osmotic pressure is too low allowing fluid to seep out of the vascular bed. E.g. if the patient has a very low serum albumin. This might also be caused by liver failure.

He's third spacing. fluid build up in the tissue, mostly in the abdomen area but it's starting to spill over into his right arm and even get into his legs. His bloodwork is showing proper levels for liver and kidneys.

My wife used to work in hospital and third spacing seemed to be a common occurance with the elderly during their last days. My biggest fear was that this was specific to end of life. It sounds from everyone's information that it doesn't always precede death. This gives me a bit of hope that we may be able to overcome the problem.

Glen,

You, your FIL and your family will be in my prayers.

Glen,

From a distance it is always difficult to diagnose. If you feel your FIL is not cared for properly by doctors who lose interest because he is old: why not have him seen by a geriatrician? They are physicians who specialise in diseases of the elderly.

Trouble is we live in an area where finding a good doctor is difficult. Most doctors in this area are usually here with a major medical facility as a career path stepping stone only. They've come to the area to get a fancy title on their resume. The family practice doctors that stay around have usually taken over someone else's practice after that doctor retired. To my knowledge there are no doctors that specialize in geriatrics in this area.

Glen F

Sad to read that getting proper medical care is so hard for your FIL.

Some clinics/hospitals offer for far away patients a one stop shop service.
I.e. patient can be admitted for one or 2 days to have all examinations and tests done. Upon diagnosis a treatment or management plan can be made up which the primary care physician should be able to execute and follow up provided no in-hospital procedures are required.

Hope this helps.

Kees