Continuous intravenous infusion parameters

Nitroprusside has a rapid onset of action and a duration of action of less than 10 minutes, necessitating its administration by continuous intravenous infusion. This allows for precise dose titration based on measured clinical and hemodynamic parameters. It, like other vasodilators used in heart failure, should be initiated at a low dose (0.1 to 0.2 mcg/kg per minute) to avoid excessive hypotension and then increased by small increments (0.1 to 0.2 mcg/kg per minute) every 5 to 10 minutes as needed and tolerated. Usually effective doses range from 0.5 to 3 mcg/kg per minute. A rebound phenomenon has been reported after abrupt withdrawal of nitroprusside in patients with heart failure and is apparently due to reflex neurohormonal... 

Adults - 10 mL (elemental iron 125 mg), may be diluted in 100 mL 0.9% sodium chloride administered by intravenous (IV) infusion over 1 hour. It may also be administered undiluted as a slow IV injection (at a rate up to 12.5 mg/min). Most patients will require a minimum cumulative dose of 1 g elemental iron administered over 8 sessions at sequential dialysis treatments to achieve a favorable hemoglobin or hematocrit response. Patients may continue to require therapy with IV iron at the lowest dose necessary to maintain the target levels of hemoglobin, hematocrit, and laboratory parameters of iron storage within acceptable limits. 

In patients presenting with propoxyphene toxicity, the airway should be patent and adequate ventilation assured. If the patient has either inadequate ventilation or a poor gag reflex, then the patient may be at risk of subsequent CO2 narcosis, worsening acidosis, and/or aspiration. If necessary, endotracheal tube intubation should be performed. The initial treatment of hypotension consists of intravenous fluids. There should be close monitoring of the patient s pulmonary parameters to ensure that pulmonary edema does not develop as fluids are infused. The patient should be placed on continuous cardiac monitoring with pulse oximetry. Frequent neurological checks should be made. Gastrointestinal decontamination should be considered only after initial supportive care has been provided and airway control has been assured. Activated charcoal (Igkg ) may be administered. 

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