Hypotension resident survival guide: Difference between revisions

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{{CMG}}; {{AE}} {{Ochuko}}
{{CMG}}; {{AE}} {{Ochuko}}, {{JA}}<br>
{{SK}} [[Low blood pressure resident survival guide]], [[Low blood pressure management guide]], [[guide to hypotension management]], [[hypotension management guide]], [[hypotension management algorithm]]


==Overview==
==Overview==
[[Hypotension]] is [[low blood pressure]], especially in the [[arteries]] of the [[systemic circulation]]. It is considered to be a [[blood pressure|systolic BP]] of less than 90mmHg or [[blood pressure|diastolic BP]] of less than 60mmHg.
[[Hypotension]] means [[low blood pressure]] (BP). A [[systolic blood pressure|systoloc BP]] measuring less than 90mmHg and/ or [[diastolic blood pressure|diastolic BP]] of less than 60mmHg is considered [[hypotension]].


==Causes==
==Causes==
===Life Threatening Causes===
===Life Threatening Causes===
Life-threatening causes include conditions which result in death or permanent disability within 24 hours if left untreated.
Life-threatening causes include conditions that result in death or permanent disability within 24 hours if left untreated.
*[[Anaphylaxis]]
*[[Anaphylaxis]]
*[[Bleeding]]
*[[Bleeding]]
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*[[Bed rest|Prolonged bed rest]]
*[[Bed rest|Prolonged bed rest]]
*[[Sepsis]]
*[[Sepsis]]
*[[Shock]]
*[[Tricyclic antidepressants]]
*[[Tricyclic antidepressants]]



Revision as of 16:29, 8 September 2020


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2], Javaria Anwer M.D.[3]
Synonyms and keywords: Low blood pressure resident survival guide, Low blood pressure management guide, guide to hypotension management, hypotension management guide, hypotension management algorithm

Overview

Hypotension means low blood pressure (BP). A systoloc BP measuring less than 90mmHg and/ or diastolic BP of less than 60mmHg is considered hypotension.

Causes

Life Threatening Causes

Life-threatening causes include conditions that result in death or permanent disability within 24 hours if left untreated.

Common Causes

Management

Shown below is an algorithm summarizing the management of hypotension.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
Blood pressure 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, hyperglycemia, 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 blood pressure 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 blood pressure 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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