Thoughts on a weird phenomenon please....

Nurses General Nursing

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My F-I-L is s/p cabg 7 yrs ago, and s/p TKR a year ago. His md frequently changes his meds around, and it has been playing havoc with his BP. He has a BP machine, which is fairly accurate +/- 10 mm hg, and his BP is so labile.

He is now only taking 3 meds, Starlix (oral antidiabetic -not even sure he needs this, md hasn't even given him a glucometer), lopressor 25 bid, and benicar hct. I know he really needs his ace and the Beta blocker, but his BP seems to drop alramingly low after eating. After the doc d/c all but these 3 mds, it is now only happening after dinner. It seemed like low BS, but he has just eaten a decent meal.

I thought my M-I-Lwas exaggerating his behavior until I saw for myself this weekend. He had 1/2 glass wine, eggplant parm, bread, and penne at the restaurant. After eating, he slumped over in his chair. My husband jiggled him and he was arousable, but out of it. We got him some coffee, but after my husband woke him, his behavior was like a sloppy drunk. Trust me, I have seen this guy drunk, he is never like he was this night. He was angry with me, for not knowing why this keeps happening to him, and he yelled about how we know what is happening but aren't telling him. He had an positively eveil little look in his eyes squinting them at me and pointing his finger. Next he's telling my husband how lucky they are to have each found good women, and how he likes me. This is stuff I know he would never normally verbalize out loud.

So, I know after eating blood is diverted to the gut for digestion, but how can he not eat??How else can this be avoided?

Any thoughts on why this is happening besides the fact that his ejection fraction is probably in the toilet? That he probably has cardiomyopathy (past history of long-term etoh use) which was not helped by the cabg?

What about something like neosynephrine nose spray or something to perk him up after eating? We got coffee into him and he did improve. I am at a loss as to what suggest to the doc, and he has been pretty unconcerned about it as far as I can see, which usually means he has no idea what to do about it either.

So, I am turning to you folks for your input. Has anyone ever seen this happen??

Thanks for any ideas.

It sounds like a combination of everything. But remember your BS isn't going to jump up immediately after eating. Is he taking his pill right before dinner or one to two houras before?

Also with his other meds, they will lower his blood pressure sometimes consistently into the 80s or 90s on some people. He may need to have that changed. And remember that the position of the arm when they are taking the BP must be at the level of the heart, if it is held up then you are going to get a low reading, and if it is down, then the reading can high.

Have you actually tried taking his BP yourself?

Could you persuade him to drink some OJ right before dinner and see if this makes a difference? Is dinner his biggest meal of the day? Does he wear a belt? I am wondering if he is diverting to much blood by overeating or putting pressure on his abdominal aorta. Long shots- but it does seem strange that this happens after dinner each time. Sounds like BP to me especially with his hx. I would call EMS after he slumps over next time it happens. Not much he can do to stop them then.

Why wait until the MD "gives" him a glucometer? Go buy one. And don't leave him alone till this is resolved. I would notify MD right away.

It sounds like "Dumping Syndrome" to me; it definitely should be checked out.

Why wait until the MD "gives" him a glucometer? Go buy one. And don't leave him alone till this is resolved. I would notify MD right away.

Great idea...Unfortunately, EVERY time I've suggested it, I either get "I have no money" or "It's the insurance's responsibilty"

:angryfire

Great idea...Unfortunately, EVERY time I've suggested it, I either get "I have no money" or "It's the insurance's responsibilty"

:angryfire

Have the doctor give you a script for the glucometer, and then go see if your F-I-L's insurance will cover it. All those commercials with Wilford White or whatever his name is says that Medicare will pay for the supplies.

Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

He doesn't have glaucoma does he? DH's ophth. stopped his timoptic and his syncopal epi's disappeared.

Is this the first DM oral he's tried? Starlix goes to work rapidly, like 20-30 mins. Perhaps he should try taking a pill box and wait til the food is ordered or on the table before taking the pill. ITA with the glucometer. He's a veteran? Perhaps he could go through the VA, DH does and they supplied one. Medicare should also with an RX.

http://www.starlix.com/pi.jsp

On the Starlix full prescribing info it says:

Starlix should be used with caution in patients with chronic liver disease

You said he has a hx of etoh, how's his liver?

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