Acute immobility syndrome

Specialty: Geriatrics.

• acute bedridden
• acute prostration
• sudden loss of standing
• acute functional paralysis of the elderly
• acute inability to ambulate

Why it occurs

• Acute ischemic or subclinical hemorrhagic stroke
• Acute systemic infection with an atypical course (urinary tract infection, pneumonia or cholangitis) without fever
• Occult osteoporotic fracture of the hip, pelvis or vertebral crush
• Acute silent myocardial infarction or acute decompensated heart failure
• Severe hydroelectrolyte disorder (profound hyponatremia or moderate-severe hypokalemia)
• Pharmacological toxicity or serious neurological adverse effects from recent prescription (neuroleptics, long half-life benzodiazepines, antihistamines)

Initial workup

Complete blood analysis with complete blood count, acute phase reactants (CRP and procalcitonin), kidney function (urea, creatinine), serum electrolytes (sodium, potassium, calcium, magnesium), venous blood gases, cardiac enzymes (troponin T or I) and liver profile; systematic analysis and urine sediment with subsequent urine culture; 12-lead electrocardiogram; PA and lateral chest x-ray; anteroposterior and lateral x-ray of the pelvis and both hips; Bedside bladder ultrasound to rule out reflex bladder ballooning.

Standard management

• Enoxaparin — 40 mg subcutaneously every 24 hours as antithrombotic prophylaxis of deep venous events during the bedridden period, reducing to 20 mg every 24 hours if creatinine clearance is less than 30 ml/min
• Paracetamol — 500 mg to 1 g every 8 hours orally or intravenously for the control of acute musculoskeletal pain without inducing sedation or cognitive impairment
• 0.9% physiological saline (slow intravenous infusion according to the patient's hydration status and baseline cardiac function to correct volume losses, monitoring lung auscultation to avoid overload).