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Emergency First Aid For Gastric Bypass Dumping Syndrome

For patients undergoing gastric bypass weight loss surgery, an episode of dumping syndrome, or rapid gastric emptying, is physically dramatic and lifestyle disruptive. 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 food that contains lactose: dairy sugar. While most patients comply with dietary guidelines, it is inevitable that they will experience an episode of dumping syndrome at some point.

Gastric dumping syndrome occurs when chewed and partially digested food leaves the stomach too quickly and enters the small intestine. This causes the pancreas to release excessive amounts of insulin into the bloodstream and symptoms of low blood sugar occur. Dumping syndrome is most commonly associated with gastric malabsorption surgery, especially gastric bypass surgery. Symptoms of dumping syndrome occur immediately after eating or within three hours of eating. Each person is unique in their response to gastric dumping, however, common symptoms can include nausea, vomiting, bloating, cramping, diarrhea, profuse sweating followed by chills, dizziness, and fatigue. When insulin levels return to normal, symptoms subside.

• Provide physical comfort: At the onset of a dumping episode the patient may initially feel disoriented or confused. This indicates that the body is starting to panic about excess insulin flooding the bloodstream. Anyone who has previously suffered from dumping will likely feel a sense of despair when they realize the onset of dumping syndrome. Providing physical comfort right now is the first response to a dumping episode. Efforts to interrupt or stop the dumping episode are futile. Many gastric bypass patients who are familiar with venting prefer to isolate themselves from others by finding a cool place to lie down. Symptoms may include vomiting or diarrhea, so patients should find a restful place near a bathroom. Many will experience a short period of profuse sweating followed by a longer period of shivering – providing a blanket is helpful in relieving shivering. A patient will reach for the blanket when needed, the carer should not attempt to cover the patient unless asked to do so. The patient may experience symptoms of sensory disturbances including 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 report that they prefer not to be comforted by their caregiver’s touch due to the acute sensitivity to touch during the dumping event.
• Hydration and electrolyte drinks: Gastric bypass patients suffering from dumping syndrome may have been mildly dehydrated prior to the dumping episode. It’s important to get your body back to a hydrated state by sipping room-temperature water or electrolyte-fortified sports drinks. Patients should be discouraged from consuming sugary drinks or juices in an attempt to correct the insulin imbalance. The body is already in a reactionary, corrective state to the insulin spike, and efforts to speed up the correction process are rarely successful.
• Seek Emergency Assistance: Patients should seek emergency medical care when symptoms of dumping syndrome persist for an extended period of time. If a patient becomes unconscious, seek emergency medical attention immediately and provide details for the patient, including the bariatric procedure, history of diabetes or hypoglycemia, and a food intake report prior to the unloading episode.

Not all patients undergoing weight loss surgery suffer from dumping syndrome. It occurs most commonly in patients undergoing malabsorption procedures, especially gastric bypass. Patients with an adjustable gastric band (abdominal band) and gastric cuff are not known to have dumping syndrome. Following a dumping episode patients should consult their bariatric center to identify the cause of the event and make a plan to avoid future episodes.

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