Unable to wean Nipride gtt

Specialties MICU

Published

Specializes in ICU.

Hello everyone.

I have had a patient in ICU on Nipride gtt for the past two nights. the patient was scheduled to have a whipple done for pancreatic CA, but upon administration of pre-op meds was found to have bp 230/140's. Came down to us and nitroprusside was started. Fast forward 2 days and I'm still trying to wean the drug. The patient is on

0.1mcg/kg/min. And on literally EVERY other anti-hypertensive (and hefty doses). She has been worked up for pheochromocytoma and so far is negative.

Any thoughts on what's going on and why this patient is so sensitive to the Nipride?

Thanks,

Jessie

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Specializes in Family Practice, Mental Health.

Did pharmacy mix the right amount of med in the bag? (Hey.....it happens)

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elevated ICP? renal issues?

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Specializes in CVICU.

Have you checked a cyanide level? Hypertension is a side effect of cyanide toxicity: http://emedicine.medscape.com/article/165886-overview

This can be caused by the Nipride...

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Specializes in CTICU.

After 2 days? Unlikely.

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Try Cardene--seems to work much better --our preferred drug at our facility.

Cindy

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Specializes in Trauma/Burn ICU, Neuro ICU.

How old is the pt? Geriatric sensitivity? or Hypothyroid?

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Nipride gtt in our facility requries an a-line--we only do those in our units--for obvious safety and manufacturers' recommendations. Cardene is also only used in our units--safety reasons only--and it usually works in just a few minutes.

Hope this helps

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I have done them on ages 20-90==all sorts of medical issues.

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Specializes in CVICU.
After 2 days? Unlikely.

Unlikely, but I've seen it happen, although it was in a much higher dose.

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Specializes in ICU.

Thanks guys! We never found out why the patient was so difficult to wean off that 0.1mcg nipride gtt!

She just transferred out of ICU yesterday. We did not check a cyanide level because she had been on and off the gtt, no consecutive use. She also didn't have any renal issues. I was stumped! Oh well, I guess whatever the issue was it resolved. I just hope she doesn't end up back in our unit later on in the week!

Thanks,

Jessie

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Specializes in ICU.

Thanks guys!

I don't think we ever found out why we were unable to wean that 0.1mcg of nipride. She did have an A-line. She didn't have any renal issues. She did not require a cyanide level as her drip was on and off, not continuous. Oh well, I hope she doesn't go into HTN crisis again, as she will end up in our unit again!

Thanks,

Jessie

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