Hydralazine, a smooth muscle vasodilator whose mechanism of action is poorly understood, is available both in tablet form and in parental form. Acute toxicity with hydralazine is uncommon, and no fatalities due to acute poisoning have been reported. Chronic use does lead to a hydralazine-induced systemic lupus erythematosus syndrome, but this generally occurs in individuals who have slow hepatic acetylation. Treatment is supportive; the hypotension associated with hydralazine responds well to intravenous fluids. Vasopressors should be used with caution in order to avoid precipitating dysrhythmias. Dopamine should be used judiciously if a vasopressor is necessary. Symptomatic tachycardia can be cautiously treated with b blockers.
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