MKSAP: 60-year-old woman with gastroparesis

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 60-year-old woman is evaluated during a routine follow-up appointment. She has gastroparesis associated with long-standing type 2 diabetes mellitus. Improved blood sugar control and efforts to eat small, frequent meals did not result in symptom improvement. In addition to these interventions, metoclopramide was started 6 months ago, after which her nausea and periodic vomiting resolved. However, she has had some restlessness at night with the urge to repeatedly cross and uncross her legs. Several weeks ago she developed a tremor in her right hand. In addition to metoclopramide, her medications are glyburide and metformin. On physical examination, blood pressure is 125/65 mm Hg and pulse rate is 75/min. Other vital signs are normal. Tremor is noted in the lower lip and resting tremor is seen in the right hand. In addition to dietary modification and blood glucose control, which of the following is the most appropriate management? A. Decrease in the metoclopramide dosage B. Discontinue metoclopramide and begin promethazine C. Gastric pacemaker placement D. Pyloric botulinum toxin injection Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Diabetes GI Source Type: blogs