SEVERE HYPOTENSION AND BRADYCARDIA AFTER CONTINUOUS INTRAVENOUS-INFUSION OF URODILATIN (ANP-95-126) IN A PATIENT WITH CONGESTIVE-HEART-FAILURE

The effects of a continuous i.v. infusion of urodilatin at a dose of 30 ng kg(-1) min(-1) were studied in a patient with congestive heart failure. After 30 min, urodilatin had induced a marked stimulation of plasma cyclic GMP concentrations. In parallel haematocrit increased. No significant diuresis and no change of invasive haemodynamics was observed. After 2 h the patient developed a profuse perspiration. Eighty minutes later he suffered from dizziness due to hypotension (blood pressure 80/40 mmHg) and a sudden bradycardia (50 bpm). Urodilatin was discontinued and symtoms were relieved by bed tilt and rapid infusion of isotonic saline solution. Mechanisms contributing to these adverse effects may be fluid extravasation to the third space and sympathoinhibitory effects known to occur with natriuretic peptide infusion.