Hypotension resident survival guide: Difference between revisions

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{{familytree | | | | | | | | | | E01 | | | | | | E02 | | | | | | | | | | E01=[[Orthostatic hypotension]]| E02=[[postprandial|Postprandial hypotension]]<br><br>Advice to eat smaller, low [[carbohydrate]] meals}}
{{familytree | | | | | | | | | | E01 | | | | | | E02 | | | | | | | | | | E01=[[Orthostatic hypotension]]| E02=[[postprandial|Postprandial hypotension]]<br><br>Advice to eat smaller, low [[carbohydrate]] meals}}
{{familytree | | | | | | | |,|-|-|^|-|-|.| | | | | | | | | | | | | | | |}}
{{familytree | | | | | | | |,|-|-|^|-|-|.| | | | | | | | | | | | | | | |}}
{{familytree | | | | | | | F01 | | | | F02 | | | | | | | | | | | | | | | F01='''Medical Therapy'''<br><br>[[Fludrocortisone]]<br><br>[[Pyridostigmine bromide]]<br><br>[[Erythropoietin]]| F02='''Lifestyle Modification'''<br><br>Regular [[BP]] monitoring with a home monitoring kit supine and prone<br><br>Maintenance of an [[salt|elevated salt intake]] of 10g/day<br><br>Maintenance of proper fluid intake to prevent dehydration<br><br>Blood sugar control}}
{{familytree | | | | | | | F01 | | | | F02 | | | | | | | | | | | | | | | F01='''Medical Therapy'''<br><br>[[Fludrocortisone]]<br><br>[[Pyridostigmine bromide]]<br><br>[[Erythropoietin]]| F02='''Lifestyle Modification'''<br><br>Regular [[BP]] monitoring with a home monitoring kit supine and prone<br><br>Maintenance of an [[salt|elevated salt intake]] of 10g/day<br><br>Maintenance of proper fluid intake to prevent [[dehydration]]<br><br>[[blood sugar|Blood sugar control]]}}
{{familytree/end}}
{{familytree/end}}



Revision as of 15:09, 9 August 2013

Hypotension Microchapters

Home

Patient Information

Overview

Historical Perspective

Pathophysiology

Causes

Differentiating Hypotension from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Hypotension resident survival guide On the Web

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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

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

References

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