Premium
Ergotamine use in severe diabetic autonomic neuropathy
Author(s) -
Toh V.,
Duncan E.,
Lewis N.,
Fichter L.,
Matthews D. R.
Publication year - 2006
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2006.01844.x
Subject(s) - medicine , midodrine , ergotamine , diabetes mellitus , dihydroergotamine , fludrocortisone , autonomic neuropathy , orthostatic vital signs , anesthesia , pure autonomic failure , surgery , blood pressure , migraine , endocrinology , hydrocortisone , biology , cell culture , genetics , neuroblastoma
Background Symptomatic postural hypotension in diabetes is uncommon. When it does occur, it can prove debilitating and difficult to treat. We report here the therapeutic challenges encountered in managing a patient with severe postural hypotension secondary to diabetes‐related autonomic neuropathy. Case report A 69‐year‐old gentleman with a 23‐year history of Type 1 diabetes mellitus and multiple microvascular complications was admitted with symptoms of severe postural hypotension. Cardiovascular autonomic testing confirmed the presence of severe autonomic neuropathy. He failed to respond to non‐pharmacological measures, fludrocortisone, midodrine, octreotide, erythropoietin and increased caffeine intake. Eventually he was commenced on half a Cafergot suppository (giving him a dose of ergotamine 1 mg and caffeine 50 mg) which resulted in dramatic clinical improvement. Conclusion Ergotamine may be considered in refractory cases of postural hypotension.