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Suggest treatment for low BP and high heart rate due to dehydration

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Pain Medicine & Palliative Care Specialist
Practicing since : 1983
Answered : 1337 Questions
Question
On admissions
Temp: 38.6
Pulse: 100/min
RR: 21/min
O2: 97% RA
BP: 105/60
Urine output: 25mls/hr

On examination, patient i presented with dehydration secondary to probable acute GE and ? caused by contaminated seafood. I had episodes of painful urination. Dr ordered IV N/S 1000ml bag with 20mmol KCI at 100 mls/hr for 8 hrs and IV N/S 1000mls at 80mls/hr. I was kept NBM and mouthcare 2 hourly. They measured my hourly IDC output and all my bowel actions Plus 4 hourly temperature, 2 hourly pulse, RR, BP, Sa02. Initially I was RIB with toilet priviledges, TEDS, 2 hourly leg exercises, shower with supervision, IDC care BD.

Medications: Metoclopramide 10mg IV 8hrly prn and Cefotaxine 1G IV 8 hrly (UTI/Cystitis)

After all implementation completes,
Temp: 37.4
Pulse: 95/min
RR: 19/min
O2: 98% RA
BP: 120/65
Urine output: 50mls/hr

I would like to find out how these could be explained using physiological level how vital signs, hydration levels and urine output responded to treatment.
Posted Sat, 23 Aug 2014 in General Health
 
 
Answered by Dr. Kerry Pottinger 4 hours later
Brief Answer:
Need fluid rehydration to improve tissue perfusion

Detailed Answer:
Hi,
Thank you for using Healthcare Magic. The presenting symptoms are secondary to significant dehydration caused by the gastrointestinal upset. Fluid replacement in the form of normal saline with potassium would be appropriate management. Broad spectrum antibiotics would be correct in the first instance.
The dehydration will have caused the low blood pressure and raised heart rate. With 2 litres of fluid these parameters have responded. Intravascular volume has improved and organs are better perfused. This has produced the improved urine output.
Further rehydration is needed to sustain the improvement.
I hope this has answered your question adequately. If you have any further queries, please do not hesitate to contact me.
Regards,
Dr K A Pottinger,
MBChB FRCA
Above answer was peer-reviewed by
 
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