Hypotension Case Studies

Offender seen today in chronic care followup of hypertension, chronic renal insufficiency, and hypothyroidism. Patient is currently in CIP. I reviewed her chart and noted that her renal function was normal in 12/2016. At the time, her blood pressure was good at 106/71. At her visit in 12/2016, it was felt that she was overly controlled and was having episodes of possible orthostatic hypotension with lightheadedness. She was on Norvasc, atenolol 50 mg once daily, hydrochlorothiazide, and lisinopril. Due to concerns about hypotension and pedal edema, her Norvasc was discontinued. At her followup visit in 01/2017, her leg edema appeared to have improved. However, around that time, she was started on imipramine 50 mg at bedtime for enuresis. At her followup visits, her hydrochlorothiazide dose was increased and then reduced, eventually …show more content…
Pedal edema. It appears that her pedal edema improved after Norvasc was discontinued, but recurred after she was placed on Tofranil 50 mg for enuresis. I suspect that this may be the cause of swelling of her hands and legs and would like to lower the dose to 25 mg for now. I would like to discontinue her Lasix and have prescribed her TED stockings to deal with the leg swelling issue. 2. Hypertension controlled. I would like to continue the lisinopril at the current dose of 20 mg a day along with metoprolol 50 mg, but would changed it from once a day dosing to 25 mg twice daily. Her Lasix is being discontinued and I anticipate improvement of her renal function, which will be rechecked in about a week's time. 3. Hypothyroidism with suppressed TSH. Patient is asymptomatic, but her TSH has been suppressed all along. I would like to reduce her dose, but we will recheck the TSH one more time as previous level drawn six weeks after her dose was reduced from 75-25 mcg a day. She will be followed up in 7-10 days time with labs prior. In the meantime, patient is aware she can schedule a sick call or send a kite if