What is the infusion rate of Isoket (Isosorbide dinitrate) in 90 ml of Peripheral Nutrition Support Solution (PNSS) for a 70kg patient?

Calculation of Isosorbide Dinitrate (Isoket) Drip for a 70kg Patient

For a 70kg patient, the appropriate infusion rate of Isosorbide Dinitrate (Isoket) in 90 ml PNSS should start at 1-10 mg/h, with careful titration based on blood pressure response, typically beginning at 0.3 mg/kg/min (21 mg/min for this patient) and titrating as needed. 1

Preparation and Initial Dosing

• For acute heart failure or coronary syndromes, prepare Isoket in 90 ml of PNSS (Peripheral Nutrition Support Solution) 2
• The initial recommended infusion rate should be 0.3 mg/kg/min, which for a 70kg patient equals 21 mg/min 2
• For patients with higher blood pressure (>140 mmHg), consider starting at the higher end of the dosing range 1
• Administer via continuous infusion using an infusion pump for precise control 1

Titration Protocol

• Increase dose in increments of 5-10 mg/min every 3-5 minutes as needed for symptom relief 2, 1
• Maximum titration can reach up to 5 mg/kg/min (350 mg/min for a 70kg patient) 2
• Target a reduction of approximately 10 mmHg in mean arterial pressure 1
• Slow titration with frequent BP measurement is recommended to avoid large drops in systolic blood pressure 2

Monitoring Requirements

• Continuous monitoring of blood pressure, heart rate, respiratory rate, and oxygen saturation is essential 1
• Consider arterial line placement for more precise monitoring in patients with borderline blood pressure 2
• Avoid administration if systolic BP <90 mmHg as it may reduce central organ perfusion 2
• Use with extreme caution in patients with aortic stenosis due to risk of marked hypotension 2

Special Considerations

• Tachyphylaxis is common after 24-48 hours, requiring incremental dosing adjustments 2
• Headache is a frequently reported side effect that may require symptomatic management 2
• For patients with acute coronary syndromes, be cautious of abrupt hypotension which can compromise coronary perfusion 2
• The venodilating effect of isosorbide dinitrate improves cardiac function by reducing preload 3, 4

Practical Application

• For a 70kg patient with 90ml solution, if using a standard infusion pump set at ml/hr:
  • Start at 1-10 mg/h (equivalent to approximately 1-10 ml/h depending on concentration) 1
  • For acute decompensated heart failure, begin at the lower end of the dosing range if BP is borderline 2, 1
  • For hypertensive emergencies or higher BP, begin at the higher end of the dosing range 1, 5
• Monitor for symptomatic improvement in dyspnea and signs of congestion 1

Cautions and Contraindications

• Do not administer if patient has right ventricular infarction 1
• Avoid in patients with severe hypotension (SBP <90 mmHg) 2
• Use cautiously in patients with renal dysfunction due to risk of hypotension 2
• May be combined with loop diuretics for enhanced effect in heart failure management 1