The effect of clonidine drip in hypertensive crisis in children

Abstract

Clonidine drip was given to 17 patients with hypertensive crisis (9 cases showed hypertensive encephalopathy) admitted to the Department of Child Health of the Cipto Mangunkusumo Hospital during a 3-year perod (March 1990 until February 1993). Various etiologies of the hypertension were encountered: 7 cases were due to acute glomerulonephritis, 4 with chronic renal failure, 2 complicated urinary tract infection, 1 Takayasu's disease, 1 viral meningitis, 1 acute cardiac decompensation (rheumatic heart disease) and 1 of unknown etiology. Clonidine was administered by titration with an initial dose of 0.002 mg/kgBW every 8 hours in a 100 ml 5% dextrosa solution, together with furosemide 1 mg/kgBW given every 8 hours intravenously. The drip was increases every 1/2 hour until the diastolic pressure decreased to less than 100 mmHg or the mean arterial pressure (MAP) reached less than 93 mmHg. The maximal dose of clinidine was 0.006 mg/kgBW/8 hours. If no reduction in diastolic pressure was obtained until the maximal dose was reached, captopril was supplemented orally. The age of the children was between 5-13 years (mean age 9 7/12), comprising of 9 boys and 8 girls. The results of treatment showed that blood pressure decreased in 4 cases (23,5%) after 30 minutes, 5 cases (29,5%) after 1 hour, 7 cases (41.2%) after 3 hours, 11 cases (64.7%) after 6 hours, 14 cases (82.3%) after 12 hours while in 3 cases (17.6%) it decreased after 24 hours of clonidine administration. The clonidine dosage used in this study was 0,002 mg/kgBW in 3 cases (17,6%), 0,004 mg/kgBW in 4 cases (23.5%) and 0.006 mg/kgBW in 10 cases (58.9%). Captopril was added orally in only 1 case. The onset of effect upon the blood pressure was 30 minutes after clonidine administration. After 6 hours of administration the systolic blood pressure decreased 24.3% the diastolic blood pressure 27% and MAP 29.7%. Within 24 hours 14 out of 17 cases showed a decrease in diastolic blood pressure less than lOOmmHg. No obvious side effect was detected during the study. In conclusion clinidine drip showed a promising effect in the treatment of hypertensive crisis in children.