1. Admit to:
2. Diagnosis: Hypertensive emergency3. Condition:
4. Vital Signs: q30min until BP controlled, then q4h.5. Activity: Bed rest
6. Nursing: Intra-arterial BP monitoring, daily weights,inputs and outputs.
7. Diet: Clear liquids.
8. IV Fluids: D5W at TKO.
9. Special Medications:
-Nitroprusside sodium 0.25-10 mcg/kg/min IV(50 mg in 250 mL of D5W), titrate to desired BP
-Labetalol (Trandate, Normodyne) 20 mg IV bolus
(0.25 mg/kg), then 20-80 mg boluses IV q10-15min
titrate to desired BP or continuous IV infusion of
1.0-2.0 mg/min titrate to desired BP. Ideal in patients
with an aortic aneurysm.
-Fenoldopam (Corlopam) 0.01mcg/kg/min IV infusion.
Adjust dose by 0.025-0.05 mcg/kg/min q15min to
max 0.3 mcg/kg/min. [10 mg in 250 mL D5W].
-Nicardipine (Cardene IV) 5 mg/hr IV infusion, increase
rate by 2.5 mg/hr every 15 min up to 15 mg/hr (25mg in D5W 250 mL).
-Enalaprilat (Vasotec IV) 1.25- 5.0 mg IV q6h.
Do not use in presence of AMI.
-Esmolol (Brevibloc) 500 mcg/kg/min IV infusion for 1minute,
then 50 mcg/kg/min; titrate by 50
mcg/kg/min increments to 300 mcg/kg/min (2.5 gm in D5W 250 mL).
-Clonidine (Catapres), initial 0.1-0.2 mg PO followed
by 0.05-0.1 mg per hour until DBP <115 (max total dose of 0.8 mg).
-Phentolamine (pheochromocytoma), 5-10 mg IV,
repeated as needed up to 20 mg.
-Trimethaphan camsylate (Arfonad)(dissecting aneurysm)
2-4 mg/min IV infusion (500 mg in 500 mL of D5W).
10. Symptomatic Medications:
-Acetaminophen (Tylenol) 325-650 mg PO q4-6h prn headache.-Zolpidem (Ambien) 5-10 mg qhs prn insomnia.
-Docusate sodium (Colace) 100-200 mg PO qhs.
11. Extras: Portable CXR, ECG, impedance cardiography,echocardiogram.
12. Labs: CBC, SMA 7, UA with micro. TSH, free T4, 24h
urine for metanephrine. Plasma catecholamines, urine drug screen.
