A patient’s blood pressure elevates to 270/150 mm Hg, and a hypertensive emergency is obvious. He is transferred to the intensive care unit and started on a sodium nitroprusside (Nipride) drip to be titrated per his response. With this medication, the nurse knows that the maximum dose of this drug should be infused for how long?
The Correct Answer and Explanation is:
The maximum dose of sodium nitroprusside (Nipride) should not be infused for more than 10 minutes.
Sodium nitroprusside is a potent vasodilator commonly used in hypertensive emergencies to rapidly lower blood pressure. It works by relaxing the smooth muscles of blood vessels, which helps reduce both preload and afterload, ultimately lowering systemic vascular resistance and blood pressure.
However, because sodium nitroprusside contains cyanide as a byproduct of metabolism, its use is carefully controlled. Prolonged administration or high doses can lead to toxicity, especially cyanide poisoning. The recommended infusion rate is generally 0.3 to 10 mcg/kg/min, but it is advised to infuse the medication for only up to 10 minutes at maximum doses to minimize the risk of toxicity.
If blood pressure has not reached the desired levels within 10 minutes, the nurse should consider switching to a different antihypertensive agent or reevaluating the treatment strategy. During infusion, careful monitoring of the patient’s blood pressure, heart rate, and signs of toxicity (e.g., confusion, metabolic acidosis, and shortness of breath) is critical.
In addition, sodium nitroprusside should be infused in an environment where immediate access to supportive measures like sodium thiosulfate (an antidote for cyanide toxicity) is available. It’s also essential to monitor for changes in cyanide levels, particularly in patients receiving high doses or prolonged infusions.
In summary, sodium nitroprusside is effective in emergencies but must be carefully dosed and monitored to avoid severe complications such as cyanide poisoning. The maximum infusion duration at high doses should be limited to 10 minutes.
