Hypertension, Acute Severe
General and supportive measures Medicine treatment Urgent referral ICD-10 code: I10 For acute or chronic hypertension, blood pressure needs to be lowered cautiously. Initiate medicines for sustained control as soon as possible to maintain the effect when the emergency measures are discontinued. Rate of BP reduction depends upon starting BP and age of the child. In the absence of central ner
General and supportive measures
Medicine treatment
Urgent referral
ICD-10 code: I10
For acute or chronic hypertension, blood pressure needs to be lowered cautiously.
Initiate medicines for sustained control as soon as possible to maintain the effect when the emergency measures are discontinued.
Rate of BP reduction depends upon starting BP and age of the child. In the absence of central nervous system signs, acute hypertension can be rapidly controlled over 24 hours. If in doubt about the duration of hypertension, reduce BP slower over 48 hours.
Aim to reduce the systolic BP with not more than ⅓ of the interval between the patient’s systolic blood pressure and the 95th percentile for that age or height in the first 8 hours, then a further gradual decline over the next 24–48 hours. Do not decrease BP to < 95th percentile in first 24 hours.
GENERAL AND SUPPORTIVE MEASURES
- Admit the patient to a paediatric intensive care unit, if possible.
- Monitor BP every 10 minutes until stable, thereafter, every 30 minutes for 24 hours.
- Set up two peripheral intravenous drips.
MEDICINE TREATMENT
Do not combine medicines of the same class.
- Furosemide, IV, 1–2 mg/kg as a bolus slowly over 5 minutes.
- If oliguric, maximum dose: 5 mg/kg/dose.
- Repeat appropriately for fluid overload.
AND
- Labetalol, IV, 0.5–3 mg/kg/hour.
- 100 mg labetalol in 80 mL sodium chloride 0.45% = 1 mg/mL.
- Infuse with an infusion pump.
- Give a bolus of 0.5 mg/kg and then titrate the dose slowly upwards until the desired blood pressure is achieved.
- Repeat, based on BP response.
If there is an inadequate response:
ADD
- Amlodipine, oral, 0.2 mg/kg/dose.
- May be repeated after 12 hours.
- Thereafter, every 24 hours.
If phaeochromocytoma suspected: Consult a specialist and refer.
Once blood pressure is controlled, taper to oral treatment.
URGENT REFERRAL
- Severe hypertension for specific diagnosis and treatment.
Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 4: Cardiovascular System , 4.11 Hypertension In Children, 4.11.1 Hypertension, Acute Severe