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A case of postprandial hypotension in an individual with cervical spinal cord injury: treatment with acarbose.
Spinal Cord Ser Cases. 2019; 5:75.SC

Abstract

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.

Authors+Show Affiliations

1Haverford College, Haverford, PA USA.1Haverford College, Haverford, PA USA.2Internal Medicine and Rehabilitation Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, 1100 Walnut Street, Suite 601, Philadelphia, PA 19107 USA.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

31632733

Citation

Farrehi, Clara, et al. "A Case of Postprandial Hypotension in an Individual With Cervical Spinal Cord Injury: Treatment With Acarbose." Spinal Cord Series and Cases, vol. 5, 2019, p. 75.
Farrehi C, Pazzi C, Stillman M. A case of postprandial hypotension in an individual with cervical spinal cord injury: treatment with acarbose. Spinal Cord Ser Cases. 2019;5:75.
Farrehi, C., Pazzi, C., & Stillman, M. (2019). A case of postprandial hypotension in an individual with cervical spinal cord injury: treatment with acarbose. Spinal Cord Series and Cases, 5, 75. https://doi.org/10.1038/s41394-019-0220-x
Farrehi C, Pazzi C, Stillman M. A Case of Postprandial Hypotension in an Individual With Cervical Spinal Cord Injury: Treatment With Acarbose. Spinal Cord Ser Cases. 2019;5:75. PubMed PMID: 31632733.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A case of postprandial hypotension in an individual with cervical spinal cord injury: treatment with acarbose. AU - Farrehi,Clara, AU - Pazzi,Carlotta, AU - Stillman,Michael, Y1 - 2019/08/30/ PY - 2019/07/16/received PY - 2019/08/01/revised PY - 2019/08/19/accepted PY - 2019/10/22/entrez PY - 2019/10/22/pubmed PY - 2020/7/25/medline KW - Neurodegeneration KW - Spinal cord diseases SP - 75 EP - 75 JF - Spinal cord series and cases JO - Spinal Cord Ser Cases VL - 5 N2 - 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. SN - 2058-6124 UR - https://www.unboundmedicine.com/medline/citation/31632733/A_case_of_postprandial_hypotension_in_an_individual_with_cervical_spinal_cord_injury:_treatment_with_acarbose_ L2 - https://doi.org/10.1038/s41394-019-0220-x DB - PRIME DP - Unbound Medicine ER -