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Hypertensive emergency successfully treated with metoprolol: a case report
1Department of Pediatrics, Madigan Army Medical Center, Tacoma,WA, USA. kirk.liesemer@us.army.mil
Pediatric Emergency Care
|May 16, 2009
Summary
This case study highlights a pediatric hypertensive emergency in a 12-year-old girl with cerebral palsy. Intravenous Metoprolol effectively managed her severe hypertension and resolved EKG changes in an emergency setting.
Area of Science:
- Pediatric Emergency Medicine
- Cardiology
- Nephrology
Background:
- Hypertensive emergencies are critical medical events, often affecting adults, characterized by severe hypertension and end-organ damage.
- Pediatric hypertensive emergencies are less common but require prompt recognition and management.
- This case involves a 12-year-old female with spastic cerebral palsy and global developmental delay.
Observation:
- The patient presented with a seizure, severe hypertension (174/112 mmHg), and tachycardia (HR 170 bpm).
- Initial electrocardiogram showed significant ST segment elevations, indicative of acute cardiac strain.
- Intravenous Metoprolol administration led to rapid normalization of heart rate and blood pressure, with resolution of EKG abnormalities.
Findings:
- Despite initial management, the patient's hypertension persisted, necessitating further investigation.
- The underlying causes were identified as gallstones and poststreptococcal glomerulonephritis.
- Effective blood pressure control was achieved with a combination of clonidine, isradipine, and amlodipine, with subsequent successful weaning.
Implications:
- This case demonstrates the potential utility of intravenous Metoprolol in managing acute pediatric hypertensive emergencies in an emergency department setting.
- It underscores the importance of a thorough workup to identify underlying causes of hypertension in children.
- Further research is warranted to establish the safety and efficacy of Metoprolol in pediatric emergency hypertension management.
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