Monday, September 23, 2013

Postprandial Hypotension

You are called for a 70 year old patient who was eating dinner and is now passed out. Upon your arrival, you notice a 70 year old patient (male or female, doesn't matter) who is laying supine on the ground. Patient is alert. The patient's son states that when they finished eating dinner, his mother "passed out." As you start to assess your patient, you have a BP if 90/52; Pulse 102; RESP 14; and Sinus Tach on the monitor. You partner informs you that you patient had eaten pasta, rolls, salad, and had a soda. Patient's history includes a previous MI, CVA, diabetic, and GERD. List of medications was note provided to you. She also has no allergies. You patient states that she does not want to go to the hospital, because she is starting to feel better. You obtain orthostatic BPs, and their is no signifiant change, at this time.

Here we go. After reading the scenario, what is your differential diagnoses?
-Vagal stimulation
-Medication "kick in"

But, have you ever thought that maybe this patient just suffered from postprandial hypotension? Let's look more into postprandial hypotension.

Postprandial hypotension is caused by a rapid decrease in blood pressure after eating a large meal. The reason that this happens, is because after you eat a large meal, all of that meal enters into your digestive tract (GI Tract). Your GI Tract requires blood. So, as more and more food enters into the GI Tract, the more blood flow that is need to help in the digestion of that food. The blood from your periphery is than moved to the core, mainly to the GI Tract. This is the normal process. But, in our geriatric population, their blood vessels do not work correctly, most of the time. In the younger population, our blood vessels will constrict, in order to help maintain a blood pressure, whereas in our geriatric population, their vessels do not always constrict, and their heart rate does not increase to help with the compensation, thus their blood pressure is not maintainable, anymore. Thus, the patient's blood pressure will fall, causing a syncopal episode. Once the patient lays supine, their body will start to compensation, because  the brain will be at the level of the heart, thus making the heart have to work less to pump the blood to the brain to keep the patient conscious.

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