Clonidine to the Rescue: A Novel Approach to Refractory Diabetic Gastroparesis in the Postoperative Setting

Abstract

Gastroparesis is a recognized complication in patients with long-standing diabetes mellitus (DM), characterized by delayed gastric emptying without mechanical obstruction. Common symptoms include nausea, vomiting, bloating, and early satiety, all of which can significantly impair both quality of life and glycemic control. Standard therapies, such as prokinetic agents (e.g., metoclopramide and domperidone) and antiemetics (e.g., ondansetron), are commonly used but may fail in refractory cases, prompting an investigation into alternative treatments. Clonidine, an α2-adrenergic agonist traditionally prescribed for diabetic diarrhea, has demonstrated promise in managing autonomic dysfunction and thus may represent a novel option for gastroparesis management. This case report describes a 65-year-old man with type 2 DM and stage 3 chronic kidney disease (CKD), presumed secondary to diabetic nephropathy, retinopathy, and peripheral neuropathy. Following orthopedic surgery, he developed severe postoperative vomiting, leading to the discontinuation of his antihypertensive therapy. After two days without antihypertensive medications, a hypertensive crisis occurred (blood pressure, 210/120 mmHg), accompanied by an acute rise in serum creatinine to 5 mg/dL, oliguria, and generalized edema. The ongoing vomiting further contributed to dehydration and worsening acute renal dysfunction. Despite receiving continuous veno-venous hemodialysis (CVVHD) for 48 hours and antiemetic treatment with metoclopramide and ondansetron for one week, his nausea and vomiting persisted. Other etiologies were excluded, and a diagnosis of diabetic gastroparesis was established. Initiation of clonidine at a dose of 100 mcg twice daily produced marked symptom improvement within 48 hours, enabling the resumption of regular oral intake and stabilization of renal function. The patient was discharged in stable condition and remained asymptomatic at his six-month follow-up appointment. This case underscores the potential of clonidine as an adjunct treatment for patients with refractory diabetic gastroparesis, highlighting its impact on autonomic regulation and symptom alleviation. Further studies are warranted to substantiate its efficacy and safety in larger patient populations.

Keywords: acute renal injury; chronic diarrea; diabetic complications; fluid status; hypertension and therapy.