Intravenous administration of nitroglycerin may be associated with a number of adverse effects.
Risk factors:
(1) high dose
(2) rapid infusion
Adverse effects of intravenous nitroglycerin:
(1) methemoglobinemia, especially with high doses
(2) vasodilation with hypotension, especially after recent sildenafil use
(3) propylene glycol toxicity with hyperosmolar acidosis with hyperlactatemia in a patient with renal insufficiency (if propylene glycol used as diluent)
(4) resistance to heparin anticoagulation
(5) headache and intracranial hypertension (with cranial nerve palsies, vomiting and altered mental status)
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