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Prevention of postprandial hypotension-related syncope by caffeine in a patient with long-standing diabetes mellitus.
Endocr J. 2020 Jun 29; 67(6):585-592.EJ

Abstract

A 74-year-old man who had type 2 diabetes mellitus of a duration of 20 years was admitted for syncope after eating a high carbohydrate meal. Although he had had episodes of pallor or syncope after carbohydrate-rich meals, such as with large amounts of white rice, several times within a year and he had been taken to hospitals emergently, the etiology of these episodes had remained unclear despite his undergoing several studies. Studies did show severe orthostatic hypotension during the head-up tilt test and a decrease in the coefficient of variation of the R-R interval (CVR-R) on resting electrocardiogram, suggesting severe autonomic nervous dysfunction. Because of the episodes of syncope after eating a carbohydrate-rich meal, we investigated whether he had postprandial hypotension (PPH). The 75 g oral glucose tolerance test revealed a significant decrease in his postprandial blood pressure by about 40 mmHg, leading to the diagnosis of PPH. The carbohydrate-rich meal test induced syncope with systolic blood pressure under 40 mmHg. Then 150 mg caffeine was administered before a second carbohydrate-rich meal. The marked decline in postprandial blood pressure was suppressed and plasma noradrenaline levels were gradually increased over a period of 60 minutes. Caffeine could be useful for prevention of postprandial hypotension-related syncope.

Authors+Show Affiliations

Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Japan. Department of Endocrinology and Metabolism, Nagaoka Red Cross Hospital, Niigata, Japan.Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Japan.Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Japan.Department of Internal Medicine, Morikawa Clinic, Niigata, Japan.Department of Bioscience and Genetics, National Cerebral and Cardiovascular Center, Suita, Japan.Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Japan.Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Japan.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

32115439

Citation

Furukawa, Kazuo, et al. "Prevention of Postprandial Hypotension-related Syncope By Caffeine in a Patient With Long-standing Diabetes Mellitus." Endocrine Journal, vol. 67, no. 6, 2020, pp. 585-592.
Furukawa K, Suzuki T, Ishiguro H, et al. Prevention of postprandial hypotension-related syncope by caffeine in a patient with long-standing diabetes mellitus. Endocr J. 2020;67(6):585-592.
Furukawa, K., Suzuki, T., Ishiguro, H., Morikawa, H., Sonoda, K., Iijima, K., Ito, M., Hanyu, O., & Sone, H. (2020). Prevention of postprandial hypotension-related syncope by caffeine in a patient with long-standing diabetes mellitus. Endocrine Journal, 67(6), 585-592. https://doi.org/10.1507/endocrj.EJ19-0370
Furukawa K, et al. Prevention of Postprandial Hypotension-related Syncope By Caffeine in a Patient With Long-standing Diabetes Mellitus. Endocr J. 2020 Jun 29;67(6):585-592. PubMed PMID: 32115439.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevention of postprandial hypotension-related syncope by caffeine in a patient with long-standing diabetes mellitus. AU - Furukawa,Kazuo, AU - Suzuki,Tatsuro, AU - Ishiguro,Hajime, AU - Morikawa,Hiroshi, AU - Sonoda,Keiko, AU - Iijima,Kenichi, AU - Ito,Masahiro, AU - Hanyu,Osamu, AU - Sone,Hirohito, Y1 - 2020/02/28/ PY - 2020/3/3/pubmed PY - 2021/6/2/medline PY - 2020/3/3/entrez KW - Autonomic neuropathy KW - Diabetes mellitus KW - Postprandial hypotension SP - 585 EP - 592 JF - Endocrine journal JO - Endocr J VL - 67 IS - 6 N2 - A 74-year-old man who had type 2 diabetes mellitus of a duration of 20 years was admitted for syncope after eating a high carbohydrate meal. Although he had had episodes of pallor or syncope after carbohydrate-rich meals, such as with large amounts of white rice, several times within a year and he had been taken to hospitals emergently, the etiology of these episodes had remained unclear despite his undergoing several studies. Studies did show severe orthostatic hypotension during the head-up tilt test and a decrease in the coefficient of variation of the R-R interval (CVR-R) on resting electrocardiogram, suggesting severe autonomic nervous dysfunction. Because of the episodes of syncope after eating a carbohydrate-rich meal, we investigated whether he had postprandial hypotension (PPH). The 75 g oral glucose tolerance test revealed a significant decrease in his postprandial blood pressure by about 40 mmHg, leading to the diagnosis of PPH. The carbohydrate-rich meal test induced syncope with systolic blood pressure under 40 mmHg. Then 150 mg caffeine was administered before a second carbohydrate-rich meal. The marked decline in postprandial blood pressure was suppressed and plasma noradrenaline levels were gradually increased over a period of 60 minutes. Caffeine could be useful for prevention of postprandial hypotension-related syncope. SN - 1348-4540 UR - https://www.unboundmedicine.com/medline/citation/32115439/Prevention_of_postprandial_hypotension_related_syncope_by_caffeine_in_a_patient_with_long_standing_diabetes_mellitus_ L2 - https://dx.doi.org/10.1507/endocrj.EJ19-0370 DB - PRIME DP - Unbound Medicine ER -