What was the lowest diastolic bp you have seen?

[Florence NightinFAIL, BSN, RN]

Hello,

Before posting this I tried searching google and allnurses forums but I wasn't able to find answers to my questions so I hope you guys can help! (What happened to the search function anyway, or did I go blind?)

2 questions:

1) I recently had a pt with BP of 124/48. She was fine, no concerns. However, I haven't seen a dbp that low and asked a fellow nurse when dpb would be considered too low and something to contact the doc about and she said she didn't know and to judge it by how the pt was doing.

I didn't pursue the question because we were pretty busy, the pt was fine, and I wanted to do some research later on.

I know that we should be considered if the sbp is below 80 or sometimes 90 depending on the pt - is there some kind of parameter for the dbp?

2) What was the lowest dpb you have seen and how was the pt doing?

Thanks!

[JenTheRN]

Personally, my norm runs in the 90's/50's. I think it would depend upon the patient. If a patient has been running high, they would certainly get symptomatic with that kind of a blood pressure. Also, you need to look at the big picture. Is this a person with a risk for bleeding of any kind? Is this person experiencing dizziness or nausea? Is this person in the end-stages of the dying process? All those will play a factor.

[murphyle, BSN, RN]

1) In general, DBP shouldn't get below 35-40 mmHg - this is the filling pressure needed for the coronary arteries to perfuse. (Remember that the coronary sinuses fill during diastole.) No coronary perfusion, of course, is a Very Bad Thing. The patient may start getting symptomatic before this point, especially if they're normally hypertensive, so I'd start getting concerned once your DBP gets below 55 or so, or your MAP (if you're monitoring it) is below 65.

2) The lowest DBP I ever saw was 32 mmHg, as in 62/32. Little old lady from LTC, sent in for hypotension (she'd been 100/70 at the home, but they hit her up with her usual BP meds anyway...), but amazingly still quite with it. Proceeded to dump her BP down to the aforementioned number within a half-hour of hitting the door. Fluid resuscitation did practically nothing for her (got her up to 78/40, oooh nice). She turned out to have raging urosepsis on top of her medication misadventure - her urine came back *chunky* and her lactate was 7-something. She wound up buying a central line, a bag of dopamine and a trip to the ICU.

Hope this helps! ?

[JenTheRN]

Oh, and I routinely see dbp of 40-45. But that's in a newborn!

[Turd Ferguson]

0

They were dead

[JenTheRN]

Turd, you made me lol.

[myk_RN]

Turd Ferguson said:

0

They were dead

ahhh! you beat me to it!

ok, seriously...

lowest one I've seen while a patient is still awake and talking is in the 40's

[NRSKarenRN, BSN, RN]

Prostate CA pt: 70/30 fully ambulatory x 3 months while on Hospice.

End stage CA Lung pt with BP 70/50 + Duragesic 500ug patches drove family to Atlantic City for the day as his final act --against my advice...family fully informed risks + DR notified...

Family relished that last act while I worried the whole weekend...he died 3 weeks later.

Seen that 0 bounce up with fluids and CPR --walked out of hospital week later.

[Turd Ferguson]

NRSKarenRN said:

Seen that 0 bounce up with fluids and CPR --walked out of hospital week later.

That's awesome... makes me smile ?

[PostOpPrincess, BSN, RN]

Zip. Zippa. Dead.

[madwife2002, BSN, RN]

Seen my own at 75/35 and I can tell you I felt like I was going to die-it was after spinal pain med. I will alway have more sympathy with my dialysis patients from now on who often have BP very very low!

[blondy2061h, MSN, RN]

I've seen teens, not doing well, got levophed.

With the BP of 124/48 I wouldn't worry, especially if the patient appeared asymptomatic, because the MAP is still acceptable at 73.