Hypertensive emergency successfully treated with metoprolol: a case report.

Abstract:

:It has been estimated that up to 27% of all medical emergencies presenting to emergency departments are due to hypertension, predominantly in the adult population. Although this often is an insidious process, acutely, a hypertensive emergency occurs when a patient presents with severe hypertension and evidence of end organ damage. We discuss the case of a 12-year-old female with spastic cerebral palsy and global developmental delay secondary to neonatal asphyxia who presented to the emergency department after having a seizure at home. On arrival to the emergency department, she was found to have a heart rate (HR) of 170 and a left upper extremity blood pressure of 174/112. Initial electrocardiogram revealed a HR of 163, with significant ST segment elevations in leads I, II, and minimal elevations in V4, 5, and 6. Intravenous Metoprolol 2.5 mg was administered 3 times with 5 minutes interval between doses, which resulted in a decline in HR (106) and blood pressure (128/86), and subsequent resolution of the electrocardiogram changes. An extensive workup revealed the patient had gallstones, however, her hypertension did not resolve with pain control and, ultimately, cholecystectomy. The remainder of her evaluation confirmed the diagnosis of poststreptococcal glomerulonephritis, and her blood pressure was, eventually, controlled with 3 medications: clonidine, isradipine, and amlodipine. Over the ensuing 2 years, these were weaned with no recurrent hypertensive episodes. Although studies have shown extended release Metoprolol to be a safe and effective treatment in children with established hypertension, to the best of our knowledge, it has not been studied in a pediatric emergency setting.

journal_name

Pediatr Emerg Care

journal_title

Pediatric emergency care

authors

Liesemer K,Mullen N

doi

10.1097/PEC.0b013e3181a34816

subject

Has Abstract

pub_date

2009-05-01 00:00:00

pages

333-5

issue

5

eissn

0749-5161

issn

1535-1815

pii

00006565-200905000-00010

journal_volume

25

pub_type

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