Hypotension resident survival guide: Difference between revisions
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*Discontinue or adjust dose of medication if hypotension is caused by medication side effects | *Discontinue or adjust dose of medication if hypotension is caused by medication side effects | ||
*Advice to wear compression stockings to relieve the pain and swelling of [[varicose veins]] | *Advice to wear compression stockings to relieve the pain and swelling of [[varicose veins]] | ||
*Early feeding either orally or by feeding tubes to prevent [[ileus]] | |||
==Don'ts== | ==Don'ts== | ||
Revision as of 15:07, 9 August 2013
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Hypotension Microchapters |
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Diagnosis |
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Treatment |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]
Definition
Hypotension is low blood pressure, especially in the arteries of the systemic circulation. It is considered to be a systolic BP of less than 90mmHg or diastolic of less than 60mmHg.
Causes
Life Threatening Causes
Common Causes
- ACE inhibitors
- Addison's disease
- Alpha blockers
- Anaphylaxis
- Beta blockers
- Bleeding
- Calcium channel blockers
- Diabetes mellitus
- Diuretics
- Hypoglycemia
- Hypothermia
- Hypovolemia
- Pregnancy
- Sepsis
- Shock
- Tricyclic antidepressants
Management
Algorithm summarizing the management of hypotension is shown below
| BP measurement | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Systolic BP < 90mmHg Or Diastolic BP < 60mmHg | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hypotension | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| History and Symptoms Detailed medication list Recent history of volume loss Dizziness or lightheadedness Syncope (fainting) Rapid, shallow breathing Nausea Blurred vision Cold clammy, pale skin | Physical Examination Heart (irregular beats) Tilt table test | Laboratory Tests CBC (anemia) Glucose (Hypoglycemia, DM) Urinalysis Blood culture Cortisol (Addison's disease) BUN | EKG Echocardiogram Stress test Valsalva maneuver | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Tilt table test positive | Tilt table test negative | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Neurocardiogenic syncope Continue with EKG and BP monitoring Beta blockers preferred initial treatment SSRI Fludrocortisone 0.1mg/day Midodrine 2.5-10 TID Scopolamine Dual chamber pacing may be required | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Orthostatic hypotension | Postprandial hypotension Advice to eat smaller, low carbohydrate meals | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Medical Therapy Fludrocortisone Pyridostigmine bromide Erythropoietin | Lifestyle Modification Regular BP monitoring with a home monitoring kit supine and prone Maintenance of an elevated salt intake of 10g/day Maintenance of proper fluid intake to prevent dehydration Blood sugar control | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Do's
- Educate the patient to avoid predisposing conditions such as dehydration, alcohol etc
- Discontinue or adjust dose of medication if hypotension is caused by medication side effects
- Advice to wear compression stockings to relieve the pain and swelling of varicose veins
- Early feeding either orally or by feeding tubes to prevent ileus
Don'ts
- Avoid or limit the use of alcohol
- Avoid standing for prolonged periods of time
- Do not cross legs while in a sitting position