Dehydration with hypertension but no tachycardia? -

Im a student paramedic, and the other day we got this patient who had been vomiting for about three days and the last time he kept any fluids or food down was two days ago. He was obviously dehydrated, and also hypertensive. What confused me was that he wasn t tachycardic. I didnt think dehydration + hypertension really went together unless there is an increased heart rate to counter the hypovolaemia. When i handed over to the triage nurse she said oh yes its probably coz he s dry . Which didnt make sense to me at all. I should have asked what she meant but didnt wanna seem stupid so i went away and had a good think about it and a chat to my partner and we still couldnt get it... anyone out there who can explain this to me?

Hello...interesting - please post more that you see. I don t have any absolute answers but this is what I m thinking. First what caused him to vomit? If it s a viral infection as opposed to adverse effects of meds will cause different responses in the body. Dehydration usually will get your sympathetics going - fight or flight response, which would typically result in tachycardia like you said. However, his hypertension was probably due to the kidney responding to his 3 day dehydration. Kidney will sense low blood volume -gt; it will increase aldosterone production -gt; cause vasoconstriction in peripheral blood vessels and retain as much water as it can (i.e. he s not peeing out the water) -gt; resulting in hypertension. The heart will sense this increase in blood pressure and as a compensatory mechanism will cause the heart to slow down. Was he bradycardic or normal heart rate? He was vomiting for 3 days before you got to him, which allowed his body time to make all these adjustments. Incredible! (Just some ideas...not sure if it makes sense). ___________________ Me again - i looked up the meds, maxolon is metoclopromide - and yeah, its supposed to help the nausea and vomiting, and tramill is essentially paracetamol with caffeine. Since he has hiatal hernia, and experienced this episode before, I don t think anything else is going on here - just the body s response to low blood volume resulting in elevated BP and a reflex bradycardia -gt; or possibly normocardia if he was tachy before hand. Looking forward to reading more cases :)

Your Pt s Samp;S are caused by his hiatal hernia. The metoclopromide is an anti-nausea/vomitting med and the tramadol was for pain relief. He was hypertensive because he was in pain, and vomitting was related to the HH. This is a fairly common condition. PS....don t listen to nurses!!!! When you have a question like this about a patient, go to the ER doc and ask him/her. Most of them are happy to explain things. It not only helps to build your knowledge base, but it also helps build a rapport with your docs.