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Pediatrics(2)

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-Acute hypertension (hypertension of sudden onset)

-Non-pharmacological

-• Admit patient to paediatric high dependence care unit

-• Monitor BP every 10 minutes until stable – thereafter every 30 minutes for 24 hours

-• Insert two peripheral intravenous drips

-• Rest on cardiac bed

-• Control fluid intake and output (restriction)

-• Restrict dietary sodium

-Pharmacological

-• do not combine drugs of the same class

-• Furosemide, IV, 1–2 mg/kg as a bolus slowly over 5 minutes, Increase up to 8 mg/kg/day

-• nifedipine 0.25-0.5mg/kg (max: 10mg) sublingual OR

-Amlodipine, oral, 0.2 mg/kg/dose. May be repeated 6 hours later, thereafter every 12 hours

-• Refer the patient to a specialist when the patient is stable

-Recommendations

-- For acute or chronic hypertension Blood Pressure needs to be lowered cautiously

-- Aim to reduce the SBP slowly over the next 24 - 48 hours,do not decrease BP to < 95th percentile in first 24 hours

-- Advise a change in lifestyle

-- Institute and monitor a weight reduction program for obese individuals

-- Regular aerobic exercise is recommended in essential hypertension

-- dietary advice

-- Limit salt and saturated fat intake

-- Increase dietary fiber intake

-Chronic Hypertension

-Non-pharmacological management

-• Introduce physical activity, diet management and weight reduction, if obese

-• Advise against smoking in teenagers

-• Follow up to monitor Blood Pressure and educate patient on hypertension

-• If Blood Pressure decreases, continue with non-drug management and follow up

-• If BP is increasing progressively, reinvestigate to exclude secondary causes or refer to the specialist

-•If BP is stable but persistently > 95th percentile and secondary causes have been excluded, start drug treatment after failed nondrug management for 6 months

-• Consider earlier initiation of drug treatment if positive family history for cardiovascular disease, essential hypertension or diabetes mellitus

-Pharmacological management

-Recommended medication and dosage for patients with chronic Hypertension

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-Recommendations

-- All patients with hypertension and persistent proteinuria should be treated with an ACE inhibitor

-- Always exclude bilateral renal artery stenosis before treating with an ACE inhibitor

-- Renal function must be monitored when an ACE inhibitor is prescribed because it may cause a decline in GFR resulting in deterioration of renal function and hyperkalaemia

-- Patients with hypertension due to a neurosecretory tumour

-(phaeochromocytoma or neuroblastoma) should receive an a-blocker either as single drug or in combination with ß-adrenergic blocker

-For patients with persistent hypertension despite the use of first line drugs, a second/third drug should be added

-Specific classes of antihypertensive drugs should be used according to the underlying pathogenesis or illness

-- For patients with a predominant fluid overload: use diuretics with/without ß-blocker

-3.9. Cardiac Arrhythmias in children

-Definition: Heart rate that is abnormally slow or fast for age or irregular.

-There are three types of arrhythmias in children

-- Heart block

-- Ventricular arrhythmias

-- Paroxysmal atrial tachycardia

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- Investigations

-- ECG is essential for diagnosis, preferably a 12 lead ECG

-- Echocardiogram

-- Other according to the suspected etiology

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- 3.10. Bradyarrhythmias

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