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Suggest Treatment For Severe Dehydration And High BP
Question: My 82 year old has had great blood pressure for the past 2 years. On average it is 130 / 72. She was taken off blood pressure medicine 2 years ago. She was recently treated for severe dehydration at the hospital after having the flu. The IV fluids that they gave her made her blood pressure go up and down during her 4 day stay in the hospital. Her echo cardiagram, EKG and telemetry all looked great but her triponenen levels were abnormal Below are the levels from her lab work:
.8
.7
8
7.1
6.8
5.1
The doctors released her and prescribed Carvedilol (Generic for Coreg) 3.125 MG. I have been tracking her blood pressure and after she takes this medicine her blood pressure drops from around 121/70 to 105/58 or 107/60 (in the general area). I am wondering if this medicine is dropping her blood pressure too low. Now that she is no longer on the IV fluids it looks like her blood pressure is stabilizing back to what it was before the hospital. My question is...should I continue to give her this medication (doctor prescribed an am and pm dose)?.
.8
.7
8
7.1
6.8
5.1
The doctors released her and prescribed Carvedilol (Generic for Coreg) 3.125 MG. I have been tracking her blood pressure and after she takes this medicine her blood pressure drops from around 121/70 to 105/58 or 107/60 (in the general area). I am wondering if this medicine is dropping her blood pressure too low. Now that she is no longer on the IV fluids it looks like her blood pressure is stabilizing back to what it was before the hospital. My question is...should I continue to give her this medication (doctor prescribed an am and pm dose)?.
Brief Answer:
We may need to observe her for some time first
Detailed Answer:
Hello and welcome.
Thank you for writing to us.
I have gone through your query with diligence and would like you to know that I am here to help. You have a very good question and have a very good observation as well.
What I need to you do for me is the following:
Measure her blood pressure at the following times for the next 2-3 days and write back to me with your readings, and we shall then decide whether or not to continue with the medications. You are quite right in suspecting that this medication may not really be required in your mother/grandmothers treatment regimen. Here are the requirements:
+Measure her blood pressure as soon as she wakes up in the morning
+After breakfast
+Before lunch
+After lunch
+Before dinner
+Before sleeping
+Before any physical activity she is regularly involved in like walking, her shower, etc.
Once you write back to me with the readings, which will be while she is still on the medication, we shall then decide whether or not to continue this medication. I would also like to add that her troponin levels do indicate a cause for concern, and I would like to ask if an EKG was conducted when her troponin levels were found as such? And could you share her results with me?
I hope you find my response helpful. Please feel free to write back to me for any further clarifications, I would be more than happy to help. I hope you understand why I choose to observe her blood pressure for 2-3 days, as I need to know and make sure what we are doing is right for her. I hope you understand and support me with the information I need. Looking forward to hearing from you.
Best wishes.
We may need to observe her for some time first
Detailed Answer:
Hello and welcome.
Thank you for writing to us.
I have gone through your query with diligence and would like you to know that I am here to help. You have a very good question and have a very good observation as well.
What I need to you do for me is the following:
Measure her blood pressure at the following times for the next 2-3 days and write back to me with your readings, and we shall then decide whether or not to continue with the medications. You are quite right in suspecting that this medication may not really be required in your mother/grandmothers treatment regimen. Here are the requirements:
+Measure her blood pressure as soon as she wakes up in the morning
+After breakfast
+Before lunch
+After lunch
+Before dinner
+Before sleeping
+Before any physical activity she is regularly involved in like walking, her shower, etc.
Once you write back to me with the readings, which will be while she is still on the medication, we shall then decide whether or not to continue this medication. I would also like to add that her troponin levels do indicate a cause for concern, and I would like to ask if an EKG was conducted when her troponin levels were found as such? And could you share her results with me?
I hope you find my response helpful. Please feel free to write back to me for any further clarifications, I would be more than happy to help. I hope you understand why I choose to observe her blood pressure for 2-3 days, as I need to know and make sure what we are doing is right for her. I hope you understand and support me with the information I need. Looking forward to hearing from you.
Best wishes.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I have a history of her blood pressure since she was discharged from the hospital. I take it several times a day. I will email it to you.
Brief Answer:
Please attach them to our discussion, my apologies
Detailed Answer:
Hello once again.
Thank you so much for that and I would much appreciate it if you could write to me with the history here as it is policy not to share personal information with the patient during an online consultation, but if at all you are unable to write the information from any two given days here, please also try to take clear images of the diary and attach it to our discussion.
If either of these do not work and you cannot go about the same, then I shall try to bend the rules and pass my email address to you. I hope you understand why I cannot do so first hand as my job is at risk, all the consultations are being monitored. I look forward to hearing from you with the attached or jotted details of blood pressure monitoring from any 2 given days whilst on the medications to control her blood pressure.
Best wishes.
Please attach them to our discussion, my apologies
Detailed Answer:
Hello once again.
Thank you so much for that and I would much appreciate it if you could write to me with the history here as it is policy not to share personal information with the patient during an online consultation, but if at all you are unable to write the information from any two given days here, please also try to take clear images of the diary and attach it to our discussion.
If either of these do not work and you cannot go about the same, then I shall try to bend the rules and pass my email address to you. I hope you understand why I cannot do so first hand as my job is at risk, all the consultations are being monitored. I look forward to hearing from you with the attached or jotted details of blood pressure monitoring from any 2 given days whilst on the medications to control her blood pressure.
Best wishes.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi doctor i have sent a reports please advice based on that
See below. Thanks for your help
DATE / TIME / BLOOD PRESSURE PULSE
12/28/14
8:00 P.M. 126 / 66 64
Day released from the hospital/ took Carvedilol (Generic for Coreg) at 11:00 p.m.
12/29/14
11:15 a.m. 115 / 63 61
took Carvedilol (Generic for Coreg) at 11:45 a.m.
4:30 p.m. 106 / 58 63
5:30 p.m. 113 / 61 65
10:30 p.m. 167 / 91 65
11:20 p.m. 163 / 87
11:45 p.m. 139 / 75 61
took Carvedilol (Generic for Coreg) at 11:30 p.m.
12/30/14
10:30 a.m. 138 / 75 58
11:45 a.m. 110 / 57 68
3:30 p.m. 109 / 62 62
9:30 p.m. 118 / 66 68
11:30 p.m. 147 / 83 63
12Midnight 151 / 80
took Carvedilol (Generic for Coreg) at 12 Midnight
12/31/14
7:00 a.m. 104 / 65 63
8:35 a.m. 128 / 66 58
took Carvedilol (Generic for Coreg) at 12:15p.m.
12:30 p.m. 138 / 75 63
took Carvedilol (Generic for Coreg) at 12 Midnight
1/1/15
11:37 a.m. 121 / 66 59
took Carvedilol (Generic for Coreg) at 12 Noon
took Carvedilol (Generic for Coreg) at 12 Midnight
1/2/15
11:30 a.m. 107 / 60
12Noon 121 / 66 58
2:45 p.m. 137 / 70 59
3:30 p.m. 110 / 64 61
6:47 p.m. 121 / 62 62
10:50 p.m. 130 / 72 61
took Carvedilol (Generic for Coreg) at 12 Midnight
1/3/15
12:10 p.m. 118 / 68 60
2:51 p.m. 121 / 62 57
5:53 p.m. 114 / 69 66
11:00 p.m. 123 / 67 65
took Carvedilol (Generic for Coreg) at 12 Midnight
1/4/15
10:30 a.m. 119 / 68 66
11:00 a.m. 116 / 62 64
4:22 p.m. 109 / 64 68
5:30 p.m. 111 / 61 65
9:22 p.m. 145 / 80 60
took Carvedilol (Generic for Coreg) at 12 Midnight
1/5/15
11:23 a.m. 105 / 59 59
12:30 p.m. 117 / 61 59
11:00 p.m. 136 / 70 60
took Carvedilol (Generic for Coreg) at 12 Midnight
1/6/15
11:50 a.m. 130 / 72 60
1:00 p.m. 118 / 65 62
9:00 p.m. 102 / 58 66
10:00 p.m. 126 / 72 70
11:00 p.m. 117 / 70 69
2:30 a.m. 126 / 72
1/7/15
11:00 a.m. 120 / 68 61
12Noon 111 / 64 65
5:30 p.m. 98 / 56 65
See below. Thanks for your help
DATE / TIME / BLOOD PRESSURE PULSE
12/28/14
8:00 P.M. 126 / 66 64
Day released from the hospital/ took Carvedilol (Generic for Coreg) at 11:00 p.m.
12/29/14
11:15 a.m. 115 / 63 61
took Carvedilol (Generic for Coreg) at 11:45 a.m.
4:30 p.m. 106 / 58 63
5:30 p.m. 113 / 61 65
10:30 p.m. 167 / 91 65
11:20 p.m. 163 / 87
11:45 p.m. 139 / 75 61
took Carvedilol (Generic for Coreg) at 11:30 p.m.
12/30/14
10:30 a.m. 138 / 75 58
11:45 a.m. 110 / 57 68
3:30 p.m. 109 / 62 62
9:30 p.m. 118 / 66 68
11:30 p.m. 147 / 83 63
12Midnight 151 / 80
took Carvedilol (Generic for Coreg) at 12 Midnight
12/31/14
7:00 a.m. 104 / 65 63
8:35 a.m. 128 / 66 58
took Carvedilol (Generic for Coreg) at 12:15p.m.
12:30 p.m. 138 / 75 63
took Carvedilol (Generic for Coreg) at 12 Midnight
1/1/15
11:37 a.m. 121 / 66 59
took Carvedilol (Generic for Coreg) at 12 Noon
took Carvedilol (Generic for Coreg) at 12 Midnight
1/2/15
11:30 a.m. 107 / 60
12Noon 121 / 66 58
2:45 p.m. 137 / 70 59
3:30 p.m. 110 / 64 61
6:47 p.m. 121 / 62 62
10:50 p.m. 130 / 72 61
took Carvedilol (Generic for Coreg) at 12 Midnight
1/3/15
12:10 p.m. 118 / 68 60
2:51 p.m. 121 / 62 57
5:53 p.m. 114 / 69 66
11:00 p.m. 123 / 67 65
took Carvedilol (Generic for Coreg) at 12 Midnight
1/4/15
10:30 a.m. 119 / 68 66
11:00 a.m. 116 / 62 64
4:22 p.m. 109 / 64 68
5:30 p.m. 111 / 61 65
9:22 p.m. 145 / 80 60
took Carvedilol (Generic for Coreg) at 12 Midnight
1/5/15
11:23 a.m. 105 / 59 59
12:30 p.m. 117 / 61 59
11:00 p.m. 136 / 70 60
took Carvedilol (Generic for Coreg) at 12 Midnight
1/6/15
11:50 a.m. 130 / 72 60
1:00 p.m. 118 / 65 62
9:00 p.m. 102 / 58 66
10:00 p.m. 126 / 72 70
11:00 p.m. 117 / 70 69
2:30 a.m. 126 / 72
1/7/15
11:00 a.m. 120 / 68 61
12Noon 111 / 64 65
5:30 p.m. 98 / 56 65
Brief Answer:
Thank you so much for your help and understanding
Detailed Answer:
Hello and thank you so much for being so co-operative.
I have gone through her blood pressure readings, and I have noticed that her blood pressure does seem to rise around evening-night time. That is around 9 pm and later, which may at times require the anti-hypertensive medications.
This elevation could have various causative factors to it like a salty meal, physical activity, etc. But since the 2nd of January, her evening-night time blood pressure seems to be stabilising, thus not requiring the anti-hypertensive at all.
In my opinion, her condition could still be a little unstable thus requiring monitoring. But I am sure she does not require the medication twice a day. You may have to monitor her blood pressure for a few more days, and if at all there is no elevation at all based on her regular daily activities then you can discontinue the anti-hypertensive completely.
But if at all there is an elevation, then you can administer the medication. In my opinion, if you do not observe an elevation at any time of the day for the next 7 days then you can completely discontinue the medication. But also report to her doctor as I am afraid she may have suffered some cardiovascular event which is why her troponin levels were elevated.
For the suspected cardiac event she suffered she may require medications, monitoring, etc. So my request would be to schedule an appointment with her doctor either way, and also report the blood pressure journal that you have maintained. I greatly appreciate the effort you have made to help her, and I am sure she will too.
I hope you find my response helpful. Please forgive me if there is anything unclear or if I have forgotten to explain anything in particular. Please do write back to me with any specific questions or for any further clarifications, I am always here to help.
Best of luck and best wishes.
Thank you so much for your help and understanding
Detailed Answer:
Hello and thank you so much for being so co-operative.
I have gone through her blood pressure readings, and I have noticed that her blood pressure does seem to rise around evening-night time. That is around 9 pm and later, which may at times require the anti-hypertensive medications.
This elevation could have various causative factors to it like a salty meal, physical activity, etc. But since the 2nd of January, her evening-night time blood pressure seems to be stabilising, thus not requiring the anti-hypertensive at all.
In my opinion, her condition could still be a little unstable thus requiring monitoring. But I am sure she does not require the medication twice a day. You may have to monitor her blood pressure for a few more days, and if at all there is no elevation at all based on her regular daily activities then you can discontinue the anti-hypertensive completely.
But if at all there is an elevation, then you can administer the medication. In my opinion, if you do not observe an elevation at any time of the day for the next 7 days then you can completely discontinue the medication. But also report to her doctor as I am afraid she may have suffered some cardiovascular event which is why her troponin levels were elevated.
For the suspected cardiac event she suffered she may require medications, monitoring, etc. So my request would be to schedule an appointment with her doctor either way, and also report the blood pressure journal that you have maintained. I greatly appreciate the effort you have made to help her, and I am sure she will too.
I hope you find my response helpful. Please forgive me if there is anything unclear or if I have forgotten to explain anything in particular. Please do write back to me with any specific questions or for any further clarifications, I am always here to help.
Best of luck and best wishes.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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