A 48-year-old man with a history of poorly controlled hypertension presents to the emergency department with sudden onset tearing chest pain radiating to his back. CT angiography confirms a Stanford Type A aortic dissection, and he is admitted to the intensive care unit where an intravenous antihypertensive medication is initiated to achieve a target systolic blood pressure below 120 mmHg. After 72 hours of high-dose infusion, the nursing staff notes he has become acutely confused and agitated. Repeat laboratories reveal a pH of 7.18, lactate of 8.2 mmol/L, and an elevated anion gap. Notably, one staff member detects a faint odor of bitter almonds near the patient's bedside. Which of the following drugs most likely caused this complication?
- A)NitroprussideGABARITO
- B)Nifedipine
- C)Fenoldopam
- D)Labetalol
- E)Hydralazine
Explicação
Nitroprusside is a rapidly acting vasodilator used in hypertensive emergencies, but prolonged use can cause cyanide toxicity. Lactic acidosis and altered mental status are classic clues because cyanide impairs oxidative phosphorylation. Ver explicação completa e trilha adaptativa →