Our patient had orthostatic hypotension, likely due to fluid and electrolyte imbalance and not autonomic dysfunction due to its acute presentation. Although, autonomic dysfunction related orthostatic hypotension could be due to his diabetes, anemia, small Left Cerebellar Infarct, HTN, or diuretic, betablockers, antihypertensive medications. Fluid and electrolyte imbalance can cause anemia and hyponatremia, and can be caused by adrenal insufficiency, diuretics, beta blockers, antihypertensive medications, diarrhea and fluid restriction/loss. Orthostatic hypotension can also be caused by being supine for extended time, which requires the body to recalibrate autonomic function with position changing. Test to fix orthostasis so PT can move forward?
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His fluid and sodium balance should be titrated by his physicians since hypovolemia (decreased plasma volume) can cause low blood pressure and ultimately orthostatic hypotension. It would be appropriate for the physicians to order lab tests of BUN, creatinine, and electrolytes and begin fluid replacement therapy. According to his diagnostic tests, his orthostatic hypotension was not due to adrenal insufficiency (which can be cause hyponatremia) because his cortisol stimulation test came back negative. Anemia can also present concomitantly with orthostatic hypotension especially due to hypovolemia and exacerbate it due to less oxygen delivery to the body, and the patient did have decreased Hgb, Hct and Platelets. Heart etiology as a cause of his orthostatics can be ruled out due to a normal echocardiogram. To make matters even more complex, our patient has a diagnosis of hypertension but paradoxically has orthostatic hypotension, this creates a dilemma for the physicians regarding medication, because treating one diagnosis can worsen the other. This hypertension concurrently with orthostatic hypotension is also a correlated sign of autonomic dysfunction/failure. His thrombocytopenia resolved over time, so that cannot be the culprit of …show more content…
His unpredictable onset of fatigue and orthostatic hypotension limited our ability to assess his true functional capacity regarding mobility each time we worked with him. It was a challenge to progress the patient due to the nature of his fluctuating medical status, and his acute hypotension with positional changes (decrease in systolic BP by more than 20 mmHg). This led to precautions for exercise prescription and gait training, and to ensure fall risk precautions as well (bed alarm, guard rails). We also made sure the head of the bed was raised up 10-20 degrees to help his body calibrate to orthostatic stress and to weaken orthostatic hypotension. We used a chair follow with ambulation due to his orthostatic hypotension, his complete blood count readings of low platelets, Hgb, Hct, and symptom report of fatigue but no dizziness. Consultations with the patient’s nurse was paramount to ensuring safety and to relay significant information to his physicians. Essentially, we did what we could since we cannot fix the patient’s medical status. The medical team wanted us to take orthostatics when working with this patient, to document the extremes and report them to help fill in the puzzle. Our clinical decision making prioritized seeing how he reacted to functional mobility day to day, we had to defer further ambulation on certain
His fluid and sodium balance should be titrated by his physicians since hypovolemia (decreased plasma volume) can cause low blood pressure and ultimately orthostatic hypotension. It would be appropriate for the physicians to order lab tests of BUN, creatinine, and electrolytes and begin fluid replacement therapy. According to his diagnostic tests, his orthostatic hypotension was not due to adrenal insufficiency (which can be cause hyponatremia) because his cortisol stimulation test came back negative. Anemia can also present concomitantly with orthostatic hypotension especially due to hypovolemia and exacerbate it due to less oxygen delivery to the body, and the patient did have decreased Hgb, Hct and Platelets. Heart etiology as a cause of his orthostatics can be ruled out due to a normal echocardiogram. To make matters even more complex, our patient has a diagnosis of hypertension but paradoxically has orthostatic hypotension, this creates a dilemma for the physicians regarding medication, because treating one diagnosis can worsen the other. This hypertension concurrently with orthostatic hypotension is also a correlated sign of autonomic dysfunction/failure. His thrombocytopenia resolved over time, so that cannot be the culprit of …show more content…
His unpredictable onset of fatigue and orthostatic hypotension limited our ability to assess his true functional capacity regarding mobility each time we worked with him. It was a challenge to progress the patient due to the nature of his fluctuating medical status, and his acute hypotension with positional changes (decrease in systolic BP by more than 20 mmHg). This led to precautions for exercise prescription and gait training, and to ensure fall risk precautions as well (bed alarm, guard rails). We also made sure the head of the bed was raised up 10-20 degrees to help his body calibrate to orthostatic stress and to weaken orthostatic hypotension. We used a chair follow with ambulation due to his orthostatic hypotension, his complete blood count readings of low platelets, Hgb, Hct, and symptom report of fatigue but no dizziness. Consultations with the patient’s nurse was paramount to ensuring safety and to relay significant information to his physicians. Essentially, we did what we could since we cannot fix the patient’s medical status. The medical team wanted us to take orthostatics when working with this patient, to document the extremes and report them to help fill in the puzzle. Our clinical decision making prioritized seeing how he reacted to functional mobility day to day, we had to defer further ambulation on certain