Hypertensive Emergency in Children

Clinical Description

Hypertensive emergencies encompass a spectrum of clinical presentations in which uncontrolled blood pressures lead to progressive or impending end-organ dysfunction

Signs and Symptoms

• Encephalopathy, convulsions, Posterior reversible encephalopathy syndrome (PRES), Visual disturbances, retinal hemorrhages, blindness.

Investigations

• As per hypertension protocol

Non-pharmacological

• Neuroprotective measures
• Nurse head at 30 degrees
• Treat seizures
• Maintain normoglycemia
• Give oxygen
• Keep temperatures normal

Pharmacological

• Assess and manage Airway, Breathing, Circulation and Disability
• Reduce BP slowly in order to prevent stroke, retinal and spinal cord infarction
• One third of the total desired reduction in the first 12 hours
• The next one third in 12 to 36 hours
• Last one third between 36 and 72 hours
• hypertensive encephalopathy: Give Hydralazine 0.15 mg/kg slow IV
• Repeat every 30-90 minutes as required
• Maximum dose: 1.7-3.6 mg/kg in 24 hours
• long term management of hypertension would depend on the cause hence these patients need to be referred for proper management.
• Labetalol
• Loading dose 0.25mg/kg IV
• Then continuous infusion of 0.25mg-3mg/kg/hour
• Sodium Nitroprusside 0.5-8mcg/kg/min continuous infusion
• If patient has oedema add frusemide 1-5mg/kg IV/PO 6 to 12 hourly

Complications

• Stroke
• Hypertensive crises
• Hypertensive retinopathy
• Hypertensive nephropathy
• Hypertensive cardiomyopathy

Complications and Referral Criteria

Refer all patients with hypertensive emergency