Persistent Hypertension Post-Norepinephrine Therapy In A Septic Shock Patient With Diabetic Ketoacidosis

Chong, Chee Ping, and Noorizan Abd. Aziz, and Yahaya Hassan, and Jahizah Hassan, (2005) Persistent Hypertension Post-Norepinephrine Therapy In A Septic Shock Patient With Diabetic Ketoacidosis. Malaysian Journal of Pharmaceutical Sciences, 3 (2). pp. 112-113. ISSN 16575-7319

Abstract

Septic shock patients usually require a potent vasoconstrictor such as norepinephrine (NE) to increase blood pressure (BP). So far, there have been no reports of NE and post-NE therapy induced persistent hypertension in septic shock patients. The objective of this communi-cation is to document a case of persistent hypertension post-NE therapy in a septic shock patient with ketoacidosis. MNN was a 41 year-old Malay male, admitted to the general intensive care unit of Hospital Pulau Pinang on March 30, 2004 due to septic shock and diabetic ketoacidosis. On admission, the patient's blood pressure was 70/50 mmHg. Norepinephrine was given for 3 days with dosage (ug/kg/ min) of 0.2 for Day 1 (Dl), 0.12 (D2), 0.04 (D3). His BP increased to 140/78 mmHg on Day 3. However, after discontinuation of NE, his BP continued to increase until it reached a maximum of 180/108 mmHg on D6. His BP remained above 160/100 mmHg from D7 to DII. Enalapril, metoprolol and frusemide were added to control the BP during this period. The patient was discharged home with oral enalapril 7.5 mg bd. Renal and liver did not contribute to this problem since both organ functions were within normal range. Other medications (ranitidine, Vitamin K, antibiotics, antifungal, insulin, midazolam and morphine) that the patient received were not likely to cause hypertension. Even though NE is a vasoconstrictor it has a short-half life. Thus, the raised in BP was suspected due to the patient's underlying hypertension. Slight increase in the hydration status also contributed to the increase in BP. In conclusion, NE is not likely to cause hypertension. The patient's underlying hypertension and intravascular volume contributed to the persistent hypertension.

Persistent Hypertension Post-Norepinephrine Therapy In A Septic Shock Patient With Diabetic Ketoacidosis

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Abstract