Document Detail

Hypertensive emergency successfully treated with metoprolol: a case report.
MedLine Citation:
PMID:  19444030     Owner:  NLM     Status:  MEDLINE    
It has been estimated that up to 27% of all medical emergencies presenting to emergency departments are due to hypertension, predominantly in the adult population. Although this often is an insidious process, acutely, a hypertensive emergency occurs when a patient presents with severe hypertension and evidence of end organ damage. We discuss the case of a 12-year-old female with spastic cerebral palsy and global developmental delay secondary to neonatal asphyxia who presented to the emergency department after having a seizure at home. On arrival to the emergency department, she was found to have a heart rate (HR) of 170 and a left upper extremity blood pressure of 174/112. Initial electrocardiogram revealed a HR of 163, with significant ST segment elevations in leads I, II, and minimal elevations in V4, 5, and 6. Intravenous Metoprolol 2.5 mg was administered 3 times with 5 minutes interval between doses, which resulted in a decline in HR (106) and blood pressure (128/86), and subsequent resolution of the electrocardiogram changes. An extensive workup revealed the patient had gallstones, however, her hypertension did not resolve with pain control and, ultimately, cholecystectomy. The remainder of her evaluation confirmed the diagnosis of poststreptococcal glomerulonephritis, and her blood pressure was, eventually, controlled with 3 medications: clonidine, isradipine, and amlodipine. Over the ensuing 2 years, these were weaned with no recurrent hypertensive episodes. Although studies have shown extended release Metoprolol to be a safe and effective treatment in children with established hypertension, to the best of our knowledge, it has not been studied in a pediatric emergency setting.
Kirk Liesemer; Neil Mullen
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Pediatric emergency care     Volume:  25     ISSN:  1535-1815     ISO Abbreviation:  Pediatr Emerg Care     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-05-15     Completed Date:  2009-08-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8507560     Medline TA:  Pediatr Emerg Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  333-5     Citation Subset:  IM    
Department of Pediatrics, Madigan Army Medical Center, Tacoma,WA, USA.
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MeSH Terms
Acute Disease
Adrenergic beta-Antagonists / therapeutic use*
Cerebral Palsy / complications
Developmental Disabilities / complications
Glomerulonephritis / complications
Hypertension, Renal / complications,  diagnosis,  drug therapy*
Metoprolol / therapeutic use*
Nephritis, Interstitial / complications
Seizures / complications
Streptococcal Infections / complications
Tachycardia / etiology
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 37350-58-6/Metoprolol

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