Natracor and low bp

[ark-two]

I recently had a patient who was started on Natracor gtt. His BNP was 4894!!! Bp in the high 80's and HR up to 200 for and steady in the 120-140. Cardiology was called and before the bolus of natracor was given and changed our standard parameters of hold for BP less than to to hold for BP less than 80. I didn't think Natracor worked for a BP of less than 90. After starting him on Natracor his BP actually went up and he started having v-tach and the increased HR. So, I kept a real close eye on him. He was made a DNR and cardi believed he was dying and would not make in a week. We gave him IV Dig for his HR only brought him down to the 110's. I noticed his urine output was decreasing and becoming concentrated. Any ideas as to what was going on with this patient? K- 5.5 BUN 48 CR 2.3 H&H normal. CXR-pulmonary edema and pneumonia. Was there any better way to treat him. I do realize that the increased HR was compensation for the low BP. I wondered if the po Digoxin would be better.

Thanks,

Jessica

PS- When I said his BP was higher, SBP was 96-92 for me

[utahliz]

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[cardiacnurse05]

I am surprised at the idea that many of the people that responded think the bnp in the 4000's is extremely high. We see patients all the time with bnp's that are in the 20,000+ range. I am also surprised to hear of natrecor being used in new chf. We only use it in end-stage chf and is more of a palliative treatment. In fact, medicare won't even pay for it anymore in our patients that come to our chf clinic. Many who are not doing as well now. In the case of this patient, I wonder if an amiodarone gtt would have been more beneficial to help reduce the rates. It wouldn't have effected the bp. Without knowing the patient's history. His renal insufficiency and pulmonary edema could have been secondary to the uncontrolled rates.