Catecholamine Induced Hypertensive Emergencies
Etiology:
- discontinuation of short-acting sympathetic blocker (e.g. clonidine, propranolol)
- pheochromocytoma
- sympathomimetic drugs (cocaine, amphetamines, phencyclidine)
- MAOI in combination with sympathomimetics or tyramine containing foods (cheese, red wine)
Treatment:
- readminister sympathetic blocker if due to withdrawal (e.g. clonidine, propranolol)
- avoid use of pure beta-blockers as they inhibit beta mediated vasodilation and leave alpha-adrenergic vasoconstriction unopposed
- best agents are
- nicardipine,
- verapamil 0,25% р-р в амп по 2 мл ( 2,5мг/мл) в/в болюсно за 2-4мин 2,5-5мг с возможным повторным введением 5-10мг ч/з 15-30мин,
- fenoldopam.
- Phentolamine 5-15mg IV bolus and
- nitroprusside 0.25-10мкг/кг/мин IV infusion
