[A case presenting a severe paralytic ileus during the continuous intravenous injection of nicardipine hydrochloride]

We report on a case of hypertensive intracerebral hematoma associated with a severe paralytic ileus during a continuous injection of nicardipine hydrochloride. The patient (63 year-old male) had been admitted with a left hemiparesis. On the second day of admission, the patient received a continuous intravenous injection of nicardipine hydrochloride following the failure to get a constant reduction of systemic blood pressure. The initial dose of the drug was 2 micrograms/kg/min. It was administered for 22 days and the average daily dosage was 187mg. On the eighth day following the beginning of the drug administration, he complained of abdominal distention. Abdominal X-ray photogram revealed a marked air collection in the colon. Despite various forms of treatments, the abdominal distention continued for 20 days until cessation of the drug administration. The paralytic ileus in this case was most likely caused by the following; 1) a relatively large amount of the drug was administered via the continuous intravenous route, 2) unexpected accumulation of the drug in the digestive tract may occur due to the dysfunction of the liver and the kidney, 3) clearance of the drug in humans may be lower than the expected value obtained from animal experiments.