Severe Diabetic Gastroparesis and Complex Discharge Planning: Home IV Cyclizine As the Only Solution

Gastroparesis is a chronic disorder characterised by delayed gastric emptying in the absence of a physical blockage. Gastroparesis can be clinically classified as mild (Grade 1), moderate (Grade 2), and severe (Grade 3), based on the severity of symptoms, with grade 3 being refractory or intractable symptoms that are not controlled despite medical therapy. Gastroparesis can occur in both type 1 and type 2 diabetes; it is more common in type 1 diabetes. Severe gastroparesis in type 1 diabetes mellitus (T1DM) can be very difficult to manage, especially when accompanied by multi-organ complications. This case highlights the importance of individualised discharge planning for a young adult with severe diabetic gastroparesis, where long hospital stays, difficult-to-treat symptoms, and multiple health problems make it very challenging to achieve quality of life and independence outside the hospital. A 29-year-old patient was admitted to the hospital with severe vomiting due to T1DM-related gastroparesis. Her case was complicated by other comorbidities, such as chronic kidney damage and nephrotic syndrome, persistent hypertension, electrolyte disturbances, and frequent diabetic ketoacidosis. During her long hospital admissions, she was started on multiple antiemetic and prokinetic medications as well as undergoing an invasive procedure of G-POEM (gastric peroral endoscopic myotomy) with no success in symptom management. No improvement was appreciated in gastric emptying studies. Due to difficulty in symptom management and dependency on IV cyclizine, which was the only medication relieving her symptoms, combined with her complex health problems and medical needs, she was compelled to stay in hospital, causing a 14-months-long hospital stay on one occasion, followed by multiple admissions, all due to same reason and a final 4-months stay when multiple multidisciplinary team (MDT) meetings were done to help her live her day-to-day life without being isolated in the hospital and give her a level of autonomy by being discharged on IV cyclizine. This case highlights the importance of an individualised patient care plan when the conventional methods fail to achieve the necessary outcome for young patient's general wellbeing and control over her life without being affected by uncontrolled symptoms, as well as the importance of MDT collaboration, when all the different healthcare professionals come together to ensure the safety of IV home medication is supported by governance and community nursing support.