It has been estimated that up to 27% of all medical emergencies presenting to emergency departments are due to
hypertension, predominantly in the adult population. Although this often is an insidious process, acutely, a
hypertensive emergency occurs when a patient presents with severe
hypertension and evidence of end organ damage. We discuss the case of a 12-year-old female with
spastic cerebral palsy and global developmental delay secondary to neonatal
asphyxia who presented to the emergency department after having a seizure at home. On arrival to the emergency department, she was found to have a heart rate (HR) of 170 and a left upper extremity blood pressure of 174/112. Initial electrocardiogram revealed a HR of 163, with significant ST segment elevations in leads I, II, and minimal elevations in V4, 5, and 6. Intravenous
Metoprolol 2.5 mg was administered 3 times with 5 minutes interval between doses, which resulted in a decline in HR (106) and blood pressure (128/86), and subsequent resolution of the electrocardiogram changes. An extensive workup revealed the patient had
gallstones, however, her
hypertension did not resolve with
pain control and, ultimately,
cholecystectomy. The remainder of her evaluation confirmed the diagnosis of poststreptococcal
glomerulonephritis, and her blood pressure was, eventually, controlled with 3 medications:
clonidine,
isradipine, and
amlodipine. Over the ensuing 2 years, these were weaned with no recurrent hypertensive episodes. Although studies have shown extended release
Metoprolol to be a safe and effective treatment in children with established
hypertension, to the best of our knowledge, it has not been studied in a pediatric emergency setting.