# Glucose D50=low BP ??



## daj72 (Jul 10, 2011)

Hey, I´have search the internet for a answer, and maybe there is nothing to it, and it was just and coincident, but can 40 ml of glucose D50, make the BP drop ?

I´had a hypoglymic(IDDM) pt yesterday with a BS on 1,2 mmol and I´ then gave him 40 ml as describe above, and for registration(journal)purpose, I measured his BP, P and sat./RR. And the only thing that was off, was the low BP 85/50.(and I´ve have never seen that "side-effect" before) And just upon our arrival the nursinghome had taken the BP to 145 Sys. Therefore I was curious about that Thrombophlebitis isn´t the only now side affect.


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## Trevor (Jul 10, 2011)

Maybe it wasnt a response to your D50? Maybe the patient was starting to decompensate after the nurse took his vitals, and prior to you getting there? Its difficult to tell, without more information.


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## MrBrown (Jul 10, 2011)

Trevor said:


> Maybe the patient was starting to decompensate after the nurse took his vitals, and prior to you getting there?



Decompensate from .... what exactly?

Brown hasn't seen it personally but personally speaking, Brown always gets an initial blood pressure regardless of what the nursing home or GP says.


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## abckidsmom (Jul 10, 2011)

MrBrown said:


> Decompensate from .... what exactly?
> 
> Brown hasn't seen it personally but personally speaking, Brown always gets an initial blood pressure regardless of what the nursing home or GP says.



If he was hypoglycemic from the metabolic demands of sepsis, and just reached the point of decompensation, I could see it.

See Rule #2:  all nursing home residents are septic until proven otherwise.


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## Trevor (Jul 10, 2011)

My first thought would be potentially from Sepsis (like said above). 

My second would be that maybe this hypoglycemia isnt "acute" and he was "just found" like this (despite being hypoglycemic for an extended period of time...)


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## daj72 (Jul 10, 2011)

Hey guys, thx. for your comments. 

I don´t suspect a second illness that could get him to decompensate. When he came up after he got Glucose D50, he was AOx3. I really think the low BP, it was a "freak of nature", but my professional pride "force me to investigate".

Brown; Me to... I also do my own measurements, and I did with the BS, regardless the nursinghome had measured (the same low) BS, I measured with my own equipment before treatment. And with the pt HX I was interested in getting the BS up, and therefore I waited to take any-other readings. And the BP came up after I toll them what I had seen on the LP15.

More case hx; He had just change the insulin dosis, hadn't eaten very much, and I suspect that is why he got the low BS.


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## 18G (Jul 10, 2011)

I would be thinking more of sepsis if they were HYPERglycemic unless they have been septic and unrecognized for a long time.  

Perhaps the nursing home was wrong with their blood pressure and it was low all along. D50 is sugar. A substance we all need. I think it's kinda like saying you gave a patient oxygen and it dropped the blood pressure. I would be looking for another cause.


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## daj72 (Jul 10, 2011)

18G said:


> Perhaps the nursing home was wrong with their blood pressure and it was low all along. D50 is sugar. A substance we all need. I think it's kinda like saying you gave a patient oxygen and it dropped the blood pressure. I would be looking for another cause.



I think, it is the case, as most(all)of you say; There is no connection between Glucose bolus and the low BP. 

Under normal circumstances the pt would stay at the nursing home after treatment, but I decided to take him to the hospital; "Dehydratio".


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## Trevor (Jul 10, 2011)

daj72 said:


> I think, it is the case, as most(all)of you say; There is no connection between Glucose bolus and the low BP.
> 
> Under normal circumstances the pt would stay at the nursing home after treatment, but I decided to take him to the hospital; "Dehydratio".



Then doesnt that explain his hypotension?????


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## daj72 (Jul 10, 2011)

Trevor said:


> Then doesnt that explain his hypotension?????



Yes, probably, but have in mind the primary call was to Hypoglycemia and there was a low BS. There were no mention of "Dehydratio". 

*I* decided is was "dehydratio" second to the low BS, because I haven't heard that glucose D50 could cause low BP, but just in case I would hear the folks in here about glucose having the side-effect giving low BP. Perhaps i´m over thinking it ;-)


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## mycrofft (Jul 10, 2011)

*We old people have multiple issues.*

Two issues could be polypharmacy and staff lying about taking vital signs.


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## Akulahawk (Jul 10, 2011)

mycrofft said:


> Two issues could be polypharmacy and *staff lying about taking vital signs.*


Another possibility is that they did take vitals... but perhaps not as recently as "just now." I've seen that more than a few times before. :unsure:


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## mycrofft (Jul 10, 2011)

*Yeah. Like twelve or more hours ago.*

Auditing those records can be chilling


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## MediMike (Jul 11, 2011)

I'm gonna have to go with a diagnosis of incompetitis vitalus.


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## Iceman26 (Jul 11, 2011)

abckidsmom said:


> If he was hypoglycemic from the metabolic demands of sepsis, and just reached the point of decompensation, I could see it.
> 
> *See Rule #2:  all nursing home residents are septic until proven otherwise.*



Absolutely fantastic rule to live by.


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