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What Causes Sudden Fall Of BP In A COPD And Hypertension Patient?

Posted on Mon, 15 Sep 2014

Question: The patient has COPD, CCF (with pacemaker and pulmonary hypertension), renal insufficiency, hypothermia, T2 diabetes, severe malnutrition, recent small pelvic fracture, suspected infection (but blood cultures negative), and has had low BP for weeks, e.g., 107/69, 104/60, 112/69, 102/62, and 106/70. If after the last BP reading it is found that BP has fallen to 85/60 and BSL to 2.0 mmol/L then does this constitute what is called "hypotension and shock"? Or is more information needed before making this diagnosis?

Answered by Dr. Deepika Patil (51 minutes later)

Brief Answer:
depends on heart rate

Detailed Answer:
Hi ,

Welcome to HealthcareMagic .

To say patient has gone into shock the bp should be less then 90 systolic and heart rate would increase to more then 100bpm and rapid. When bp falls heart rate should raise as compensatory mechanism.

Only if patient is taking from long time b -blocker drugs then heart rate will be on lower side .

With bp and heart rate we may suspect shock . Along with this we need some supporting findings to confirm the diagnosis like
-dehydration
-low urine output
-confusion
-restlessness
-dearrangement of PT and INR
-shortness of breath and low SpO2
-altered acid base balance
-sourse of infection or haemorrhage
-hypothermia
-dearrangement of renal parameters etc

Blood culture may come negative in suspected sepsis due to use of prior antibiotics etc.

According to your query I feel patient has gone into shock.

Hope I have answered your query . If any further queries are there I would love to help.

Regards
Dr.Deepika Patil

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Deepika Patil (1 hour later)

Dear Dr. XXXXXXX Thank you for your answer. I hope that the following information is of help in diagnosing whether the patient is in shock. HR is 85 (not on b-blocker); RR is 25; BP now 86/48; Temp is 35.6 (afebrile for weeks); GCS is 13; NRB is 96.1; hypoxic in recent days and patient has had delirium for 3 days; nil by mouth for 3 day and on IV fluid. This morning's pathology results: Sodium 157 mmol/L; Potassium 3.4 mmol/L; Urea 34.0 mmol/L; Creatinine 204; Estimated GFR 28; WCC 13.9; HB 119 g/L; PLT 401; Left Shift +; PT Test 23.2 secs; INR 2.2; C Reactive Protein 162. If the patient isn't already in shock but BP goes up to 100 bpm then would that confirm shock? Could you say that the patient is likely to be in shock at present on the basis of this additional information?

Answered by Dr. Deepika Patil (4 hours later)

Brief Answer:
likely to be in shock

Detailed Answer:
Hi,

After going through the additional reports I conclude that the patient might be in early stage of shock.

The heart rate is not raised may be because of pacemaker and CCF.

When cause of shock is treated BP will go up. That means patient is responding to treatment and that confirms shock .

Hope I have answered your query . If any further queries are there I would love to help.

Regards
Dr.Deepika Patil

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Deepika Patil (30 minutes later)

Thank you very much Dr XXXXXXX for your medical advice. Even though you cannot examine the patient and don't have 100% information, what would you advise should be done now to reverse the decline? Would you cease administration of the 120 mg BD Lasix (frusemide)? How could the particular cause of the early stage of shock be established?

Answered by Dr. Deepika Patil (37 minutes later)

Brief Answer:
reducing lasix may increase BP

Detailed Answer:
Hi,

Usually after reducing the dose of lasix BP may go up itself. As lasix is known to reduce BP. I would suggest to discuss regarding the need for continuation of lasix that dose weighed against its side effect of lowering BP.

It is difficult to assess without examining the patient whether lasix to be continued or reduced etc.

If lasix can't be reduced then inotropic drugs may be started . And also maintain hydration and nutrition adequately with antibiotic coverage. This should reverse the decline.

Low BP and renal insufficiency and hypothermia itself establish the diagnosis of early stage of shock .

Hope I have answered your query . If any further queries are there I would love to help.

Regards
Dr.Deepika Patil

Note: For further follow-up it is advisable to consult an emergency medicine specialist. Click here.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari