Aspiration Pneumonia (risk via delayed gastric emptying)
Users on Reddit, including medical professionals, report serious concerns and experiences regarding aspiration pneumonia linked to delayed gastric emptying while on GLP-1 medications. They also discuss various preventative measures, particularly in the context of medical procedures.
User Experiences with Aspiration Pneumonia and Delayed Gastric Emptying:
Aspiration During Medical Procedures: Delayed gastric emptying is a primary concern during procedures requiring anesthesia. A user shared, "Have seen a pt aspirate during intubation 2/2 the delayed emptying, despite compliance with NPO. "[2] Another reported, "Pretty bad aspiration of undigested food on induction of anesthesia in a patient who had been appropriately NPO. "[3] A similar case involved an adult patient who "aspirated, went into shock, significant ICU admission. "[5]
Microaspiration and Pneumonia: One detailed account described a patient on their first GLP-1 dose who experienced "delayed gastric emptying + snoring = microaspiration --> PNA --> sepsis --> ICU + almost ended up intubated, 5 day total hospital stay. "[4]
Significant Delayed Gastric Emptying: Users report food remaining in the stomach for extended periods. A nurse in surgery noted, "It's wild to me that a patient could've eaten 2 days ago and still have enough food in their stomach to aspirate. "[23] An anesthesiologist shared an experience where a POCUS scan on a patient who "hadn’t eaten in over two days... showed solids in the antrum. Woke the patient up and pulled the tube…still groggy, she puked up easily identifiable solid food (it had raisins in it... ). "[17] Another user on GLP-1s for type 1 diabetes recounted, "3 weeks in, I tried to eat a lettuce-wrapped burger from Carls Jr. That burger sat in my stomach for about 48hrs before coming back up the way it came. "[14]
Gastroparesis and Related Symptoms: Some users mention the risk of GLP-1s causing gastroparesis. [13] One user described symptoms like "feeling like food was caught in my chest, that I couldn't quite get it down. " (This user had dyspepsia symptoms, not explicitly aspiration pneumonia, but it highlights severe DGE).
Aspiration from Vomiting: A user mentioned seeing "a few with aspiration due to vomiting," which is a known side effect of GLP-1s. [12]
Mechanism (as described by users):
This can be a new pathology or worsen existing conditions. One comment pondered if "the glp-1 make existing pathology worse? dont think of this as a side effect, think of this like a pathology to manage. "[6]
Remedies and Preventions Recommended by Users (Primarily for Procedural Settings):
However, effectiveness is debated. One user noted an aspiration event in a patient who was off the medication for one week, leading their institution to switch to a two-week hold. [9] Another reported that even after a seven-day hold and NPO compliance, patients still had food in their stomachs on ultrasound. [8]
Dietary Adjustments Pre-Procedure:
Following new ASA guidelines, some institutions "no longer hold the medication but patients are told to be on a clear liquid diet for 24h prior to surgery. "[18] Another user stated, "We aren’t holding anymore, just 24 hour clear liquid diet and gastric ultrasound if that isn’t followed. "[20]
Procedural Precautions (Anesthesia):
Rapid Sequence Intubation (RSI): Recommended for emergent surgeries or high-risk patients. [23] If gastric ultrasound shows food in an urgent case, one user would "probably proceed with RSI as long as the patient understands the elevated risk. "[21]
Routine Intubation: One anesthesiologist who frequently encounters undigested food ("pool ball sized bezoars") in patients on GLP-1s stated, "I do a ton of GI and the junk that is there has convinced me to just tube them all. "[16]
Gastric Ultrasound (POCUS): Increasingly used to assess stomach contents. "I’ve done pre-op ultrasound on a couple of patients who had adequate NPO and last dose of GLP-1 seven days prior. They both had food in their stomach. "[8] If food is detected, elective cases might be canceled. [21]
General Management/Awareness:
For patients with Obstructive Sleep Apnea (OSA), one user highlighted the importance of CPAP use to prevent microaspiration if GLP-1s are continued, especially with delayed gastric emptying. [4]
Users emphasize being cautious about food choices due to slowed digestion.
User Experiences with Aspiration Pneumonia and Delayed Gastric Emptying:
- Severe Aspiration Events: Some users report devastating outcomes.
Mechanism (as described by users):
- Delayed gastric emptying is consistently identified as the underlying cause.
Remedies and Preventions Recommended by Users (Primarily for Procedural Settings):
- Holding Medication Pre-Procedure:
- A common recommendation is to stop GLP-1 medications before procedures.