A 31-year-old woman with no asthma or cardiac disease has acute severe hypertension at 36 weeks with BP of 172/114 mmHg. IV access has been secured. Labetalol is chosen. What is the correct initial IV dose?
- A 5 mg bolus over 1 to 2 minutes
- B 20 mg bolus over 2 minutes ✓
- C 50 mg bolus over 5 minutes
- D 100 mg continuous infusion over 30 minutes
Correct answer: B. 20 mg bolus over 2 minutes
Explanation
The standard intravenous labetalol regimen starts with 20 mg given over 2 minutes, followed by escalating doses of 40 mg then 80 mg every 10 minutes if needed, up to a cumulative maximum of 300 mg. The 5 mg dose belongs to hydralazine protocols. Starting too low wastes time in a hypertensive emergency where the goal is bringing BP below 160/110 within 30 to 60 minutes.
Reference: Williams Obstetrics, 26th ed.
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