Hypertension Emergency Treatment

Initial treatment will be that of the presentation. Airway, breathing, and circulation should be assessed and managed in the usual way and neurological status assessed and monitored. Convulsions usually respond to lorazepam or diazepam and patients with clinical signs of raised intracranial pressure should be managed as in Chapter 12.

Once the patient has been resuscitated, management of the hypertension is urgent, but should only be commenced after discussion with a paediatric nephrologist or paediatric cardiologist because of the dangers of too rapid reduction.

Monitoring of visual acuity and pupils is crucial during this time as lowering the blood pressure may lead to infarction of the optic nerve heads. Any deterioration must be treated by urgently raising the blood pressure using intravenous saline or colloid. Some children may be anuric - renal function (serum creatinine, urea, and electrolytes) should be analysed promptly.

Some drugs commonly used to achieve blood pressure reduction in children are shown in Table 13.1.

Table 13.1. Drug therapy of severe hypertension

Drug

Dose

Comments

Labetalol

16-50 ^g/kg/min

a- and B-blocker. Titratable infusion. DO NOT USE in patients with fluid overload

Sodium nitroprusside

Very easy to adjust dose.

Protect from light. Monitor cyanide levels

Hydralazine

0-2-1 ^g/kg/min

Vasodilator. Titratable infusion. Adjust as required

Nifedipine

0-25 mg/kg

Vasodilator. Fluid can be drawn up from capsules and squirted into mouth sublingually.

Better to bite the capsule and swallow. May be difficult to control BP drop because it is given as a bolus

Some specialists may recommend the use of nifedipine as a temporary measure before transfer; if any drug is used, the child should have the blood pressure monitored as above and an intravenous infusion in place.

These children should be cared for in a unit experienced in paediatric hypertension. This will usually be the regional paediatric nephrology (or paediatric cardiology) centre. It is essential that adequate consultation takes place before transfer.

CHAPTER

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