Orthostatic hypotension: Difference between revisions
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* Symptomatic orthostasis more important than actual change in vitals
* Symptomatic orthostasis more important than actual change in vitals
* Classically drop in SBP ≥20 mm Hg or increase in HR ≥ 30 bpm when moving from lying to standing
* Classically drop in SBP ≥20 mm Hg or increase in HR ≥ 30 bpm when moving from lying to standing
** Studies show that orthostatic vitals common at baseline health, and not necessarily abnormal in acutely ill <ref>Ooi WL, Barrett S, Hossain M, Kelley-Gagnon M, Lipsitz LA. Patterns of Orthostatic Blood Pressure Change and Their Clinical Correlates in a Frail, Elderly Population. JAMA. 1997;277(16):1299–1304. doi:10.1001/jama.1997.03540400049030</ref><ref>Skinner, J. E., Driscoll, S. W., Porter, C. B. J., Brands, C. K., Pianosi, P. T., Kuntz, N. L., Nelson, D. E., Burkhardt, B. E., Bryant, S. C., & Fischer, P. R. (2010). Orthostatic heart rate and blood pressure in adolescents: Reference ranges. Journal of Child Neurology, 25(10), 1210-1215. https://doi.org/10.1177/0883073809359539</ref>
** Studies show that orthostatic vitals common at baseline health, and not necessarily abnormal in moderate volume loss <ref>Ooi WL, Barrett S, Hossain M, Kelley-Gagnon M, Lipsitz LA. Patterns of Orthostatic Blood Pressure Change and Their Clinical Correlates in a Frail, Elderly Population. JAMA. 1997;277(16):1299–1304. doi:10.1001/jama.1997.03540400049030</ref><ref>Skinner, J. E., Driscoll, S. W., Porter, C. B. J., Brands, C. K., Pianosi, P. T., Kuntz, N. L., Nelson, D. E., Burkhardt, B. E., Bryant, S. C., & Fischer, P. R. (2010). Orthostatic heart rate and blood pressure in adolescents: Reference ranges. Journal of Child Neurology, 25(10), 1210-1215. https://doi.org/10.1177/0883073809359539</ref><ref>McGee S, Abernethy III WB, Simel DL. Is This Patient Hypovolemic? JAMA. 1999;281(11):1022–1029. doi:10.1001/jama.281.11.1022</ref>


==Clinical Features==
==Clinical Features==

Revision as of 19:22, 28 March 2020

Background

  • More common in older patients
  • Symptomatic orthostasis more important than actual change in vitals
  • Classically drop in SBP ≥20 mm Hg or increase in HR ≥ 30 bpm when moving from lying to standing
    • Studies show that orthostatic vitals common at baseline health, and not necessarily abnormal in moderate volume loss [1][2][3]

Clinical Features

  • Sudden postural changes resulting in cerebral hypoperfusion
  • Weakness, lightheadedness, visual blurring
  • Occasionally syncope

Differential Diagnosis

Evaluation

  • Review medication list
  • History of potential volume loss
  • CBC (anemia)
  • BMP (electrolytes, BUN, Cr, glucose)
  • EKG

Management

  • Address the underlying cause
    • Fluids, blood transfusion when appropriate
    • Consider discontinuing at risk medications

Disposition

Depends on patient's risk, etiology of orthostasis disposition, secondary complications

See Also

External Links

References

  1. ↑ Ooi WL, Barrett S, Hossain M, Kelley-Gagnon M, Lipsitz LA. Patterns of Orthostatic Blood Pressure Change and Their Clinical Correlates in a Frail, Elderly Population. JAMA. 1997;277(16):1299–1304. doi:10.1001/jama.1997.03540400049030
  2. ↑ Skinner, J. E., Driscoll, S. W., Porter, C. B. J., Brands, C. K., Pianosi, P. T., Kuntz, N. L., Nelson, D. E., Burkhardt, B. E., Bryant, S. C., & Fischer, P. R. (2010). Orthostatic heart rate and blood pressure in adolescents: Reference ranges. Journal of Child Neurology, 25(10), 1210-1215. https://doi.org/10.1177/0883073809359539
  3. ↑ McGee S, Abernethy III WB, Simel DL. Is This Patient Hypovolemic? JAMA. 1999;281(11):1022–1029. doi:10.1001/jama.281.11.1022
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