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Emergency first aid for gastric bypass syndrome and dumping

For gastric bypass weight loss surgery patients, an episode of dumping syndrome, or rapid gastric emptying, is physically dramatic and lifestyle disrupting. Before surgery, patients are instructed to avoid sweet processed carbohydrates, fatty fried foods, and all simple processed carbohydrates to avoid dumping syndrome. Some patients who become lactose intolerant with weight loss surgery (WLS) experience dumping after eating foods that contain lactose – milk sugar. While most patients adhere to dietary guidelines, it is inevitable that at some point they will experience an episode of dumping syndrome.

Gastric emptying syndrome occurs when partially digested and chewed food leaves the stomach too quickly and enters the small intestine. This causes the pancreas to release excessive amounts of insulin into the bloodstream, causing symptoms of hypoglycemia. Dumping syndrome is most commonly associated with gastric malabsorption surgery, specifically gastric bypass surgery. Symptoms of dumping syndrome will manifest immediately after eating or within three hours after eating. Each person is unique in the gastric discharge response, however common symptoms may include nausea, vomiting, bloating, cramps, diarrhea, profuse sweating followed by chills, dizziness, and fatigue. When insulin levels return to normal, the symptoms disappear.

  • Provide physical comfort: At the beginning of a shock episode, the patient may first notice a feeling of disorientation or confusion. This indicates that the body is beginning to panic from excess insulin flooding the bloodstream. Someone who has been dumped in the past will probably feel desperate upon realizing the onset of dumping syndrome. Providing physical comfort at this time is the first response to a dumping episode. Efforts to interrupt or stop the spill episode are futile. Many gastric bypass patients familiar with pouring prefer to isolate themselves from others to find a cool place to lie down. Symptoms can include vomiting or diarrhea, so patients should find a quiet place near the bathroom. Many will experience a brief period of profuse sweating followed by a longer period of chills – providing a blanket is helpful in relieving the chills. A patient will reach for the blanket when needed, the caregiver should not attempt to cover the patient unless asked to do so. The patient may experience symptoms of sensory disorder that include extreme and abnormal sensitivity to light, sound, and touch. These are transient symptoms and many patients find relief when the lights are dimmed and they rest in a low noise environment. Many patients say they prefer not to be comforted by their caregiver’s touch due to the acute sensitivity to touch during the shock event.
  • Hydration and electrolyte drinks: Gastric bypass patients with dumping syndrome may have been mildly dehydrated prior to the dumping episode. It is important to return the body to a hydrated state by drinking water at room temperature or sports drinks fortified with electrolytes. Patients should be discouraged from drinking juices or sugar-sweetened beverages in an effort to correct the insulin imbalance. The body is already in a reactionary and corrective state to the rise in insulin, and efforts to speed up the correction process are rarely successful.
  • Seek emergency care: Patients should seek emergency medical attention when the symptoms of dumping syndrome last for a long period. If a patient loses consciousness, seek emergency medical attention immediately and provide details for the patient, including the bariatric procedure, history of diabetes or hypoglycemia, and a report of food intake prior to the shock episode.

Not all patients undergoing weight loss surgery experience dumping syndrome. It occurs more frequently in patients with malabsorption procedures, specifically gastric bypass. Lap-band and gastric sleeve patients are not known to have dumping syndrome. After an episode of dumping, patients should consult with their bariatric center to identify the cause of the event and make a plan to avoid episodes in the future.

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