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Yesterday he was lucid fine and we had a good conversation. Today he is totally bats! Thinks he's been moved to a different state. I live in Colorado and cannot travel to Florida. Other siblings also are far away. Who will decide what happens next?

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My late sister-in-law had trouble with low sodium; her organs were failing due to chronic kidney disease & non-alcoholic cirrhosis of the liver. She did not have any vomiting issues or lack of nutrition going on when her sodium levels dropped, just to note. When sodium levels drop in the body, confusion also occurs at the same time, which we did see with her. *She did not pass away from the aforementioned issues but from Covid-19

The doctor may want your brother to go to rehab in a Skilled Nursing Facility after his hospital stay, depending on how weak he is or if he needs PT and OT, or they may send him home if they feel he can manage on his own. Stay in touch with the doctor & the nurse at the hospital and good luck!
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Has sodium been replaced? Does your brother by any slim chance have a drinking problem. It is unusual for sodium to go out of whack without severe vomitting or lack of nutrition. It would be normal with low sodium to have confusion, perhaps even loss of consciousness, but I assume his sodium is now replaced. Is there a chance this could be withdrawal, drugs? Have they done testing on alcohol and drug levels.
Your best guide in all of this is the doctors. I wish you luck in managing this by phone, but the doctors and nursing staff are the ones to rely on. If you are not listed on any advanced directive one family member will likely be chosen as the person to notify of condition.
This is very difficult from another area of the country. I have done it and found it almost impossible, so I understand, but really there is no choice. Without a family member being appointed as the temporary guardian to make decisions the Social Worker is the best one to explain what happens next, and to help put a family member (who is willing) in place for decisions and information. Form a phone tree with siblings and decide who will wish to do this.
I am assuming your brother has no one in his area to act for him.
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theolddonna Jan 2022
They were replacing the sodium, and also doing several MRI's of the abdomen and one of the brain. He has been in AA for over 35 years, no alcohol problems. He (due to memory and dementia) has not been eating well or even at all some days. He has lost a lot of weight. He has no close friends to act for him locally. I will call the Patient Advocate Office tomorrow and try to find out what can be done, and by whom. Thank you for the information and just for a bit of support.
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Here's a good link on low sodium:

https://www.mayoclinic.org/diseases-conditions/hyponatremia/symptoms-causes/syc-20373711
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Does anyone have Power of Attorney for Health and/or Finances?

Consider communicating with the doctors, nursing staff, discharge planning office and/or Patient's Advocate office.
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