Question

A 42 year old female patient presents to the ED with complaints of  postprandial nausea associated with signs and symptoms related to severe hypoglycemia: Dizziness, tachycardia, and decreased consciousness. She has a history of gastric bypass surgery. What is the most likely explanation for her symptoms? What is the anticipated treatment?

Answer 1

Ans) The clinical presentation of dumping syndrome can be divided into GI symptoms and vasomotor symptoms.

- GI symptoms include early satiety, crampy abdominal pain, nausea, vomiting, and explosive diarrhea.

- Vasomotor symptoms include diaphoresis, flushing, dizziness, palpitations, and an intense desire to lie down.

- The expression of these symptoms varies in different individuals. Most patients with early dumping have both GI and vasomotor symptoms, while patients with late dumping have mostly vasomotor symptoms. Patients with severe dumping often limit their food intake to avoid symptoms. This leads to weight loss and, over time, malnutrition.

- After gastric surgery, it can be more difficult to regulate movement of food, which dumps too quickly into the small intestine. Eating certain foods makes dumping syndrome more likely. For example, refined sugars rapidly absorb water from the body, causing symptoms.

• Anticipate the condition:

- Don't drink liquids until at least 30 minutes after a meal.
- Divide your daily calories into 6 small meals.
- Lie down for 30 minutes after a meal to help control the symptoms.
- Choose complex carbohydrates such as whole grains.

- Avoid foods high in simple carbohydrates, such as those made white flour or sugar.

- Add more protein and fat to your meals.

- Stop eating dairy foods, if they cause problems.

Another option is to slow gastric emptying by making your food thicker. Healthcare provider may advise adding 15 grams of guar gum or pectin to each meal. But many people don’t tolerate these additions to their food.

If dietary changes don’t help, healthcare provider may give you some slow-release prescription medicines. In rare cases, these may help, but they often don’t work. In severe cases of dumping syndrome, your healthcare provider may suggest tube feeding or corrective surgery.