Q: 53 years old male with ESRD (End Stage Renal Disease) is in the ICU. The nurse requested a PRN medicine for BP control. Intravenous (IV) Hydralazine is written. One hour after administration of Hydralazine, the patient developed a mental status change.
Answer: In patients, particularly with renal failure/uremia, hydralazine may produce a marked decrease in blood pressure, resulting in central reactions such as anxiety, delirium, disorientation, depression, and coma.
Also, Hydralazine is a cerebral vasodilator and is known to increase intracranial pressure, which, together with its effect upon systemic blood pressure, reduces the cerebral perfusion pressure.
#pharmacology
#hemodynamics
#nephrology
#CVS
#neurology
References:
1. Schroeder T, Sillesen H. Dihydralazine induces marked cerebral vasodilation in man. Eur J Clin Invest. 1987 Jun;17(3):214-7. doi: 10.1111/j.1365-2362.1987.tb01238.x. PMID: 3113965.
2. Mutimer CA, Yassi N, Wu TY. Blood Pressure Management in Intracerebral Haemorrhage: when, how much, and for how long? Curr Neurol Neurosci Rep. 2024 Jul;24(7):181-189. doi: 10.1007/s11910-024-01341-2. Epub 2024 May 23. PMID: 38780706; PMCID: PMC11199276.
3. Talseth T. Studies on hydralazine. II. Elimination rate and steady-state concentration in patients with impaired renal function. Eur J Clin Pharmacol. 1976 Sep 30;10(5):311-7. doi: 10.1007/BF00565619. PMID: 976304.
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