From the Guidelines
Routine administration of IV fluids during administration of nitrates to counteract hypotension is not recommended as a standard practice. While IV fluids can help maintain blood pressure in patients who develop significant hypotension from nitrates, they should be administered selectively rather than prophylactically 1. When nitrate-induced hypotension occurs, a 250-500 mL bolus of normal saline (0.9% NaCl) can be given, with additional fluid as needed based on the patient's response and clinical status.
The decision to administer fluids should consider the patient's baseline volume status, cardiac function, and comorbidities. Patients with heart failure or renal dysfunction may be particularly vulnerable to volume overload 1. Nitrate-induced hypotension occurs because these medications cause venodilation and arterial dilation, reducing preload and afterload, which decreases cardiac output and blood pressure.
Some key points to consider when administering nitrates include:
- Monitoring blood pressure regularly during nitrate administration is essential for early detection and management of hypotension 1
- Alternative approaches to managing nitrate-induced hypotension include placing the patient in Trendelenburg position, temporarily discontinuing the nitrate, reducing the dose, or slowing the rate of administration
- Nitrates should not be administered to patients with hypotension or to those who received a phosphodiesterase inhibitor 1
- The use of other anti-ischemic therapies with proven benefits, such as beta blockers, should not be precluded by the administration of nitrates 1
From the FDA Drug Label
Because the hypotension associated with nitroglycerin overdose is the result of venodilatation and arterial hypovolemia, prudent therapy in this situation should be directed toward increase in central fluid volume. Passive elevation of the patient’s legs may be sufficient, but intravenous infusion of normal saline or similar fluid may also be necessary The administration of IV fluids during administration of nitrates to counteract hypotension is recommended as a therapy to increase central fluid volume in the event of an overdose. The use of IV fluids, such as normal saline, may be necessary to counteract hypotension caused by nitroglycerin overdose 2.
From the Research
Administration of IV Fluids with Nitrates
- The administration of IV fluids during the administration of nitrates to counteract hypotension is not directly addressed in the provided studies 3, 4, 5, 6, 7.
- However, the studies discuss the use of nitrates in the management of angina pectoris and the potential for nitrate tolerance with continuous therapy 4, 5, 6, 7.
- The studies suggest that intermittent therapy with nitrates can help prevent the development of tolerance 5, 6, 7.
- The use of IV fluids may be considered in patients experiencing hypotension due to nitrate therapy, but this is not explicitly stated in the provided studies.
- The potential side effects of nitrates, including postural hypotensive symptoms, are mentioned in the studies 4, 7.
- The importance of careful dosing regimens and patient monitoring is emphasized in the studies to minimize the risk of adverse effects, including hypotension 4, 5, 6, 7.