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What Causes Fluctuations In Blood Pressure Readings In An Elderly Person?

Posted on Sat, 21 Jan 2017

Question: A 94 year-old relative has end-stage dementia and is confined to bed in a hospital. She is being administered oral morphine and paracetamol for severe back pain after suffering a fall. Initially, she was on normal saline. After it was decided not to administer N/S anymore her systolic BP fell to about 102 for a few days. However, over the last two days her systolic BP has gone up to 116 and then over 150 despite the fact that her oral intake of fluid (as well as food) has declined in this time. I cannot make any sense out of this. Do yo have any possible explanation?

Answered by Dr. Ivo Ditah (1 hour later)

Brief Answer:
How is here pain managed? Is it well controlled?

Detailed Answer:
Hi,

I have reviewed her information fully. Her pain is the most likely explanation for this increased blood pressure. Check to make sure she's having no pains. Check with the nursing staff on this and let me know what you find.

I wish you well.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ivo Ditah (1 hour later)

Thank you Dr. Ditah. I visit my relative every day (but not at night) and from what I can tell she is not in any pain. She doesn't report pain when asked (although most of the time she is incomprehensible because of her dementia) and her body-language does not indicate it. She has moments of alertness but is very somnolent. Could the cause be urinary retention in her bladder. She sometimes indicates slight abdominal discomfort but does not describe it as pain. I am at a complete loss over this.

Answered by Dr. Ivo Ditah (7 hours later)

Brief Answer:
What are the recent readings?

Detailed Answer:
Hi,

What are the recent readings of her blood pressure? Urinary retention could cause that but am sure she either has a foley catheter for urine evacuation in place or puts on diapers.

Her blood numbers are not too bad. We should have more readings to correctly see at what times they go up and whether there is a specific pattern that could help orient us on this.

I wish you well and hope to hear back from you!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ivo Ditah (38 hours later)

Thank you again Dr. Ditah. The relative's geriatrician was on leave for a few days but I spoke to him today. The patient is terminal and he explained that the rise in BP despite the fall in the intake of fluid (as well as today's rise in the pulse rate which was around 120 plus per minute) was the body's way of compensating. I am sure that the geriatrician will monitor the relative very well. But he is not available 24 hours per day. Are there any signs that I could look for when the relative's death is imminent, although I appreciate that not all patients are the same?

Answered by Dr. Ivo Ditah (10 hours later)

Brief Answer:
Deteriorating level of consciousness and LAert!

Detailed Answer:
Hi,

The most common signs are worsening state of consciousness, incoherent speech, and breathing difficulties. Others may pass on peacefully and quietly in their sleep while others may actually be agitated. However, the medical staff can often have a sense when the vital parameters of blood pressure, breathing and heart rates are falling apart.

I wish you well.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar