Hypersensitivity to administered adrenaline in tetraplegia.

Abstract

STUDY DESIGN:

Case report.

OBJECTIVE:

To describe two clinical examples of denervation hypersensitivity, an enhanced response to catecholamines demonstrated experimentally in tetraplegic patients.

SETTING:

USA.

CASE REPORTS:

A 63-year-old man with chronic paralysis at C4 ASIA Impairment Scale (AIS) A with partial preservation to T6, and a history of coronary artery and pulmonary disease, developed bradycardia leading to cardiac arrest. He was treated with intravenous atropine 0.4 mg and adrenaline 1 mg. He regained consciousness and blood pressure within 30 s, but developed supraventricular tachycardia leading to ventricular fibrillation and death within minutes. The dose of adrenaline was routine for a cardiac arrest.A 60-year-old man with chronic paralysis at C6, AIS A, presented with fever to 106 degrees F and a renal stone. Thirty minutes after treatment with intravenous fluids, antibiotics, and 1 g aspirin orally, he became afebrile, then suddenly lost consciousness and palpable pulse. He recovered with equal rapidity after an intravenous injection of 0.1 mg adrenaline. The dose of adrenaline was a tenth the usual dose for cardiac arrest.

CONCLUSION:

Because of denervation hypersensitivity, effective treatment of a cardiac arrest in tetraplegic patients may require a reduced dose of adrenaline.

• Authors: J H Frisbie
• Journal: Spinal cord (Spinal Cord) Vol. 47 Issue 3 Pg. 264-5 (Mar 2009) ISSN: 1362-4393 [Print] England
• PMID: 18594552 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Vasoconstrictor Agents
• Epinephrine

Topics

• Epinephrine (adverse effects)
• Heart Arrest (chemically induced)
• Humans
• Male
• Middle Aged
• Quadriplegia (drug therapy)
• Vasoconstrictor Agents (adverse effects)
• Ventricular Fibrillation (chemically induced)