My father suffers from bouts of severe diarrhea, blood pressure drops and passes out typically all occuring in a about 30 minutes! It's very sudden, can be feeling fine one minute, then gets nauseated and the diarrhea hits. We can not link it to any food that he eats or any other triggers. He has been to his local MD, GI and even two trips to Mayo Clinic. Almost all tests are negative. Has anyone else ever experienced this? What was the diagnosis and treatment? Thanks so much in advance for your help!
I have the same problem. I have never actually passed out from it but I have to lay on the floor in order to prevent it. It always hits me at 4:30 am. It hurts so bad it feels like vultures are pecking at my stomach. Horrible, horrible pain. I get up, go to the bathroom, and it eventually works its way out in about 30 minutes or so. I don't know if it helps you to know that I have autoimmune disease that affects all of my body tissues. I never know what weird ailment I'll come down with next. The stomach issues tend to occur when I'm under high amounts of stress and anxiety. I hope that helps and he can find some relief. Librax works for me. I only take it when I feel symptoms coming on.
I would assume he has been checked for Crohn's Disease and ulcerative colitis with endoscopy and colonoscopy? Does he have low sodium or potassium ever from the diarrhea? That can cause low BP and fainting. The fainting is dangerous, and every attempt should be made to find out why this is happening. Obviously, diarrhea causes dehydration, and the elderly are particularly prone to it and changes in their BP. Does he ever get flushing, like red cheeks and sweats along with the diarrhea? If so he should be checked for a carcinoid tumor in GI tract. It can be screened for initially with a urine test for 5HIAA, and if elevated he needs endoscopy. These tumors are rare but cause release of neurochemicals that affect GI tract, and cause blood vessels to dilate. They also can cause asthma symptoms.
He has been tested for all of those and they are all negative. He has a couple of markers for endocrine tumors that were elevated, but after repeat tests (Octreotide twice, MRI, colonoscopy, endoscopy, esophageal ultrasound of pancreas) no tumors can be found. No flushing, no asthma symptoms. Potassium has been low. He always has to go to the ER and get fluids. He has had 5 spells since 2012 and all have required admission except this last one, but he got to the ER much sooner and received fluids quicker so I think that helped. He is afraid to go anywhere outside our home town because when they hit they are so quick! He is looking at taking herbal medications at this point because he feels like he has to do something. Even the Mayo Clinic can't figure it out.
In what order do the symptoms occur? Has he ever been checked with a Holter monitor to see if he is having a cardiac arrhythmia that precedes the symptoms? Sometimes, the heart rhythm goes awry, then you get an autonomic (involuntary nervous system) response which can include nausea, diarrhea, low BP and fainting. Depending on how often this occurs, I think a cardiac monitor for a period of time adequate to cover an episode would be helpful. Most arrhythmias can be prevented with medication or devices if that is the culprit. A low potassium can make those arrhythmias more likely so it seems he should be on a potassium supplement.
His symptoms are almost every 6 months. His Potassium is normal except for during the spells then returns to normal again. He has been on the heart monitor during the events and no abnormalities there. Symptoms are as follows: feels nauseated, stomach starts to churn, then sudden explosive completely water diarrhea occurs. Then BP drops and he passes out. Also to note, spells (5 to date) have always occurred in the morning hours, like around 10:00am.
How low does your Dad's potassium go? Is he weak in muscles either before or after these events? There is a periodic hypokalemic paralysis that could be going on, characterized by sudden episodes of low potassium, muscle weakness or paralysis, nausea and diarrhea. Does he actually lose consciousness when he faints or does he just fall down/collapse? It is a hereditary thing, so would be good to identify. It can also be triggered by heavy carbohydrate or salt intake, so diet modifications are used to prevent attacks. Just a thought-this is certainly something unusual. Do you know what neuroendocrine markers were elevated? If you can find that out, I may be help more.
I think the potassium was just slightly low, I can review his hospital labs to give you a specific level if that is needed. (I'm a physician assistant so I have access to his records). No real weakness in muscles, but cramps during the spells. Generalized weakness afterwards though. He has lost consciousness, but not for long. No other family members with similar symptoms. Human pancreatic polypeptide was elevated at 586. Calcitonin, VIP, serontonin, and chromogranin levels were all normal. Also to note, his Hydrogen Breath test was frankly positive at 211. This has been repeated twice, the past time was last week with the methane level in the 40's. He is going to try Probiotics as he feels he needs to do something. Waiting on a return call from Mayo to determine if treatment for small bowel overgrowth is again needed. I'm curious "ladybud" what your profession is?
Kelly, with the new info on PPP being fairly elevated, I have another theory which could explain it all, but this is of course academic discussion. Let's say your Dad eats a hearty breakfast at 7:00 AM loaded with carbs, like pancakes, waffles etc. The carbs stimulate insulin release, perhaps too much or too late, and drops his blood sugar to 40 at around 10:00 AM, typical timing for hypoglycemia. The low blood sugar triggers the nausea, diarrhea, and drops his BP and he passes out. The excess insulin has driven his serum potassium intracellular, so now he is low on K+ too. This could be figured out if any glucose measurements were taken early during an episode. An insulinoma in the pancreas could be the culprit, and many are too tiny to show up on CT but will show up on MRI better. You can also get serum insulin levels measured, best fasting to rule out insulinoma. If he has another episode, family members or paramedics should do an immediate glucose determination to try to capture it before it recovers back to normal. This could be severe reactive hypoglycemia, but this is rather extreme, and I think in view of PPP being high, an adenoma should be ruled out. Hope you can find some glucose determinations in his paramedic records and at least get a serum insulin measurement done.
Last edited by ladybud; 02-05-2014 at 08:27 AM.
Sounds like he has "vasovagal "..where his blood pressure drops suddenly to cause fainting. I have this. It was diagnosed via a Table tilt test. Medical term for it is : Neurocardiogenic syncope. If I get a stomach virus or food poisoning which causes diarrhea I get the fainting feeling. To avoid the fainting. I put my legs up against a wall to get the blood flowing back to upper area of body.
You might want your dad to be seen by an electrophysiologist ( cardiologist that deals with the electrical system of the heart).
However..guess they must identify why he is having these bouts of diarrhea as that happens first and then the fainting issue.