Sodium Nitroprusside Toxicity in a Young Infant Following Cardiac Surgery
Davide Silvagni
Paediatric and Neonatal Intensive Care Unit, Department of Paediatrics, Major City Hospital, Azienda Ospedaliera Universitaria Integrata Verona, Italy.
Marco Bolognani
Paediatric and Neonatal Intensive Care Unit, Department of Paediatrics, Major City Hospital, Azienda Ospedaliera Universitaria Integrata Verona, Italy.
Maria A. Prioli
Division of Cardiology, Department of Medicine, University of Verona, Italy.
Giovanni Battista Luciani
Division of Cardiothoracic Surgery, Department of Surgery, University of Verona, Italy.
Pierantonio Santuz
Paediatric and Neonatal Intensive Care Unit, Department of Paediatrics, Major City Hospital, Azienda Ospedaliera Universitaria Integrata Verona, Italy.
Paolo Biban *
Paediatric and Neonatal Intensive Care Unit, Department of Paediatrics, Major City Hospital, Azienda Ospedaliera Universitaria Integrata Verona, Italy.
*Author to whom correspondence should be addressed.
Abstract
Adverse effects associated with sodium nitroprusside (SNP) administration are rarely observed in children. Monitoring of metabolic changes appears to be the most sensitive and accurate indicator of early toxicity. We report a case of acute toxicity in a 3-month-old boy treated with high-dose SNP infusion for systemic hypertension after elective coarctectomy, who developed seizures and severe lactic acidosis. We suggest blood lactate levels and base excess levels should be carefully monitored during SNP treatment in children, in order to detect early signs of toxicity, particularly when using high infusion rates.
Keywords: Sodium nitroprusside, toxicity, lactic acidosis, cyanide, thiocyanate, infant, SNP sodium nitroprusside, CN cyanide, SCN thiocyanate.