tailieunhanh - A Lange Medical Book Pediatrics on call - part 4

Âm thanh bị bóp nghẹt tim hoặc xa có thể là một đầu mối để tràn dịch màng ngoài tim như là một phần pancarditis virus hoặc do tràn dịch màng ngoài tim tự hoại. 9. Bụng. Kiểm tra thường đòi hỏi các chiến thuật diversionary. Kết quả thi, chẳng hạn như đau địa phương thường cần phải được lặp đi lặp lại từ phương pháp tiếp cận khác nhau để xác nhận việc tìm kiếm | 45. HYPERTENSION 217 5. Enalaprilat. Effective in 5-10 mcg kg doses q8-24h. Because neonates have a more active renin-angiotensin system they are more sensitive to drug than older children and should be given dose in lower range. Closely monitor renal function and serum potassium level. 6. Hydralazine. Old but trustworthy drug given at mg kg as a bolus. Maximum dose per bolus is 20 mg. Can be repeated q3-4h. Monitor heart rate and hold doses if significant tachycardia. Watch for resistance to BP-lowering effect. 7. Diazoxide. Extremely effective can cause precipitous drop in BP and elevate blood glucose concentration. If normal saline infusion is available at bedside to treat acute hypotension 1-3 mg kg quick IV push works well. Second bolus can be given within 5-15 minutes if needed not to exceed 5 mg kg combined dose. Effective dose can be repeated q4-24h. B. Hypertensive Urgency. Symptomatic hypertension without evidence of end-organ damage. Oral treatment is acceptable although IV medications may also be considered. Long-acting oral agents ie those recommended in once- or twice-daily doses should be avoided due to delayed peak concentration. 1. Sublingual nifedipine. No excessive side effects reported in pediatric literature frequently administered convenient drug of choice for pediatric hypertensive urgencies if administered in appropriate dose. Conventional dose is mg kg per dose q3-4h not to exceed 10 mg per dose or 3 mg kg day. Although labeled as sublingual absorption takes place from stomach so capsule needs to be opened before being swallowing. 2. Oral hydralazine. Doses of mg kg q4-6h may work well. Maximum one-time dose is 25 mg with cumulative daily dose of 5 mg kg. 3. Minoxidil. More powerful vasodilator than hydralazine with more side effects. In acute situations mg kg may work well. Add diuretic if treatment exceeds a few days. 4. Propranolol. Given in doses of mg kg q6-12h. 5. Chronic hypertension. Not within