A case of postprandial hypotension in an individual with cervical spinal cord injury: treatment with acarbose.
| Autor: | Farrehi C; 1Haverford College, Haverford, PA USA., Pazzi C; 1Haverford College, Haverford, PA USA., Stillman M; 2Internal Medicine and Rehabilitation Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, 1100 Walnut Street, Suite 601, Philadelphia, PA 19107 USA. |
|---|---|
| Jazyk: | angličtina |
| Zdroj: | Spinal cord series and cases [Spinal Cord Ser Cases] 2019 Aug 30; Vol. 5, pp. 75. Date of Electronic Publication: 2019 Aug 30 (Print Publication: 2019). |
| DOI: | 10.1038/s41394-019-0220-x |
| Abstrakt: | Introduction: Postprandial hypotension (PPH) is a postmeal drop in systolic blood pressure that may or may not be symptomatic. While the etiologies of PPH are incompletely understood, it is thought to occur when glucose absorption causes increased splanchnic blood flow or "pooling" in people who lack sufficient compensatory responses to support their systemic blood pressure. Postprandial hypotension is well described in individuals with neurodegenerative diseases, yet only rarely in people living with spinal cord injury (SCI). Acarbose is an alpha-glucosidase inhibitor that treats PPH by slowing gastric transit time and reducing glucose uptake in the small intestine, hence decreasing superior mesenteric artery blood flow. Case Presentation: A 62-year-old woman with long-standing cervical SCI presented with 5 years of worsening postprandial lightheadedness, visual "flashes", and neck pain. She had had multiple episodes of near and frank syncope and her prior medical team had initiated midodrine three times daily. We began treatment with acarbose, starting at 50 mg with each meal and rapidly titrating to 100 mg at mealtime. She noticed an immediate improvement in her symptoms and an attenuation of postmeal drops in both systolic and diastolic blood pressures. Discussion: To our knowledge, this is one of the first described cases of PPH among people living with SCI. Given the autonomic dysfunction that frequently accompanies higher-level of injuries, it is possible that many more people with SCI have this condition, whether or not it is symptomatic. Acarbose is one of the several established treatments for PPH, and proved effective and tolerable for our patient. Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest. (© International Spinal Cord Society 2019.) |
| Databáze: | MEDLINE |
| Externí odkaz: |
|