Indication
Refractory hypertensive emergency (with β-blocker in dissection), afterload reduction in severe HF.
Preparation
50 mg in 250 mL D5W; wrap bag in foil.
Dilution
200 mcg/mL
Rate
Start 0.25–0.3 mcg/kg/min; titrate q5 min; max 10 mcg/kg/min for ≤10 min.
Monitoring
- • Continuous arterial BP
- • Lactate, ABG (metabolic acidosis = cyanide toxicity)
- • Thiocyanate level if >72 h or renal failure
Common errors
- • Prolonged high-dose infusion → cyanide toxicity
- • Exposure to light — degrades drug
- • Rapid titration → precipitous hypotension
Pearls
- • Antidote for cyanide toxicity: hydroxocobalamin 5 g IV
- • Add β-blocker first in aortic dissection to prevent reflex tachycardia
