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What Should I Do About Lethargy, Confusion, GERD And Blood Pressure?
Question: I am a RN, my husband is 52, Hx of GERD and HTN. He takes Nexium 40mg qd and Benicar 25/12.5 qd. BP 118/72. Sent to ER Saturday September 8. CT neg an labs WNL. he was lethargic, confused to situation and date. He was fine sunday and Monday. came home from work 4hrs early. Now again has new onset of confusion but not as bad as sunday. CT was of his brain. July 18 dx concussion and there is no changes since july per ct scan. What could I possible be missing. PCP appointment not until Thursday the 13th.
Brief Answer:
This could be due to postural hypotension.
Detailed Answer:
Hello,
He has sudden onset confusion and lethargy. His blood pressure is normal. CT scan brain is also normal. The confusion is occurring in episodes. He is on Nexium which is Esomeprazole and Benicar which is Olmesartan. First thing we should look into is that if the symptoms are due to some side effects of these drugs.
Olmesartan is known to result in dizziness, lightheadedness which could present as drowsiness. Confusion and drowsiness could be due to postural hypotension. So his blood pressure should be checked in lying down position and immediately on standing. If there is significant fall then that is due to hypotension. This could cause confusion, drowsiness.
Other possibility is transient ischemic attacks. His CT is normal but TIA might present with similar symptoms. Though its possibility is very rare. His routine investigations should be done and blood work up should be done. His lipid profile and CBC should be done. This will help in ruling out other possibilities. Also, please tell me if he has in recent past had any ear or throat infection or cold with fever? This will rule out any ENT cause.
Please provide more details in follow up. Thanks.
Regards
This could be due to postural hypotension.
Detailed Answer:
Hello,
He has sudden onset confusion and lethargy. His blood pressure is normal. CT scan brain is also normal. The confusion is occurring in episodes. He is on Nexium which is Esomeprazole and Benicar which is Olmesartan. First thing we should look into is that if the symptoms are due to some side effects of these drugs.
Olmesartan is known to result in dizziness, lightheadedness which could present as drowsiness. Confusion and drowsiness could be due to postural hypotension. So his blood pressure should be checked in lying down position and immediately on standing. If there is significant fall then that is due to hypotension. This could cause confusion, drowsiness.
Other possibility is transient ischemic attacks. His CT is normal but TIA might present with similar symptoms. Though its possibility is very rare. His routine investigations should be done and blood work up should be done. His lipid profile and CBC should be done. This will help in ruling out other possibilities. Also, please tell me if he has in recent past had any ear or throat infection or cold with fever? This will rule out any ENT cause.
Please provide more details in follow up. Thanks.
Regards
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Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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