Open AccessUltra‐high dose intravenous nitroglycerin in an ESRD patient with acutely decompensated heart failure
Author(s) -
Gyory Michael,
Abdallah Samantha,
Lagina Anthony,
Levy Phillip D.,
Twiner Michael J.
Publication year - 2021
Publication title -
journal of the american college of emergency physicians open
Language(s) - English
Resource type - Journals
ISSN - 2688-1152
DOI - 10.1002/emp2.12387
Subject(s) - medicine , preload , afterload , pulmonary edema , heart failure , anesthesia , intravenous infusions , hemodialysis , intensive care unit , intravenous therapy , intravascular volume status , cardiology , hemodynamics , lung
Acute cardiogenic pulmonary edema is a highly unstable and potentially lethal condition that is most commonly associated with markedly elevated blood pressure (BP). Use of nitrates, diuretics, and non‐invasive positive pressure ventilatory support are the mainstays of early intervention and stabilization. Use of high‐dose bolus intravenous nitroglycerin, which causes both preload and afterload reduction, has shown significant promise in studies to date, reducing the need for endotracheal intubation (ETI) and intensive care unit admission. To date, the highest recorded total dose of nitroglycerin used during the initial stabilization of acute pulmonary edema has been 20 mg. Here, we describe a patient with end‐stage renal disease who developed acute cardiogenic pulmonary edema and received a total of 59 mg nitroglycerin (56 mg push dose intravenous + 3 mg intravenous drip) over 41 minutes leading to successful stabilization and avoidance of ETI, facilitating rapid initiation of emergent hemodialysis.