nipride toxicity

Did you guys draw labs?

do you mean nipride level. no we did not. after 8 days they did creatinine clearance which was high. they asked the docs and the docs stated dont need to.

OK, it's been awhile, but when I woked in critical care whenever we had someone on nipride for an extended period of time (forgive me, I can't remember the details of the policy) we regularly drew labs to check for cyanide toxicity.

So, this pt was on nipride for 8 days and no one checked for cyanide toxicity?

We don't normally draw labs to check for cyanide tox. We do try to keep patient on lower doses of nipride and use other things to supplement. I would be concerned about cyanide tox, esp on 8 mcg (which is ton of cc, at least the way we mix it). As for the blood in urine, was the nurse checking ptts? Sometimes with heparin gtts, the urine is bloody but ptts ok, so we just monitor. If ptt high we adjust accoriding to our protocol. Certainly with the other symptoms, I would have tried another drug just to be sure...

Nipride started at 8mcg/kg/min is very high. It is recommended to start this infusing at 0.5mcg/kg/min and titrate to a desired BP. Anything higher than a 2.5 to 3.0 mcg/kg/min for 2-3 days should be monitored for cyanide toxicity. Nipride toxicity rarely happens however, renal patients and liver patients are more susceptible.

A cyanide kit is always available at the pharmacy. ask for one. if you suspect a toxic level, recommened the kit. then let the patient sniff it.

Also, if the patient is not responsive to this agent, change this dilator to something else.

Whenever a patient is experiencing neuro changes while on Nipride suspect toxicity!!!!! We just had a patient that this happened to. She was on Nipride for several days and became almost incoherent!!!!! She was not talking, would not respond, and had an overall glazed over look about her. CT scans came back negative, EEG negative, so they finally sent a Cyanide level!!!!! Bingo that was the problem. The patient is now up walking, and feeding herself once again. Some patients have no problem with Nipride, others are more suspectible. Just like anything else I guess!

Where I work, Nipride is a standard drug post op, we start at 0.2mcg/kg/min and on our unit, max is 5mcg/kg/min (10mcg/kg/min in the ICU). Have only drawn a thiocyanate level once. We also use other meds to assist in BP control so we can wean the Nipride off timely. MMB