Labetalol

Dose: 20 mg IV bolus then 2 mg/min IV to target BP

See: Infusion Pump

Preparation of IV infusion:
Dilute 200 mg labetalol in 160 mL of a compatible IV solution for a final concentration of 1 mg/mL. Alternatively, dilute 200 mg in 250 mL of a compatible IV solution for a final concentration of approximately 2 mg/3 mL. Compatible IV solutions include 0.9% Sodium Chloride, 5% Dextrose in Water, Lactated Ringer's, or 5% Dextrose/0.9% Sodium Chloride .

Solution:(calculate cc/minute)

or

Sodium Nitroprusside

Dose: 0.5 mcg/kg/min to max (10 mcg/kg/min)

 

Evaluate for the presence of heart failure: jugular venous distention, crackles on auscultation, and peripheral edema.

Chest pain may indicate myocardial ischemia or infarction,

back pain may denote aortic dissection, and

dyspnea may suggest pulmonary edema or congestive heart failure.

1. There are 3 categories of patients:when the BP exceeds 180/110 mm Hg,

   1. Severe hypertension—BP >180/110 in the absence of symptoms beyond mild or moderate headache without evidence of acute target organ damage.

   2. Hypertensive urgency—BP exceeds 180/110 mm Hg with significant symptoms, such as severe headache or dyspnea, but absent or only minimal acute target organ damage.

   3. Hypertensive emergency—BP >220/140 mm Hg accompanied by evidence of life-threatening end-organ dysfunction.

Hypertensive emergencies include accelerated hypertension, defined as progressive hypertension with the funduscopic vascular changes of malignant hypertension but without papilledema, and malignant hypertension, defined as a severe hypertensive state with papilledema of the ocular fundi and vascular hemorrhagic lesions, thickening of the small arteries and arterioles, left ventricular hypertrophy, and a poor prognosis.

Target Organ Manifestations

Complications of Injecting Drug Use

• Local problems—Abscess (Figures 240-2 
  

  A 32-year-old woman with type 1 diabetes developed large abscesses all over her body secondary to injection of cocaine and heroin. Her back shows the large scars remaining after the healing of these abscesses. (Courtesy of ­Richard P. Usatine, MD.)

  and 240-3; Abscess), cellulitis, septic thrombophlebitis, local induration, necrotizing fasciitis, gas gangrene, pyomyositis, mycotic aneurysm, compartmental syndromes, and foreign bodies (e.g., broken needle parts) in local areas.2
  • IDUs are at higher risk of getting methicillin-resistant Staphylococcus aureus(MRSA) skin infections that the patient may think are spider bites (Figure 240-4).
  • Some IDUs give up trying to inject into their veins and put the cocaine directly into the skin. This causes local skin necrosis that produces round atrophic scars (Figure 240-5).
• IDUs are at risk for contracting systemic infections, including HIV and hepatitis B or hepatitis C.
  • Injecting drug users are at risk of endocarditis, osteomyelitis (Figures 240-6and 240-7), and an abscess of the epidural region. These infections can lead to long hospitalizations for intravenous antibiotics. The endocarditis that occurs in IDUs involves the right-sided heart valves (see Chapter 50, Bacterial Endocarditis).2 They are also at risk of septic emboli to the lungs, group A β-hemolytic streptococcal septicemia, septic arthritis, and candidal and other fungal infections.