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Hypersensitivity to administered adrenaline in tetraplegia.

AbstractSTUDY 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.
AuthorsJ H Frisbie
JournalSpinal cord (Spinal Cord) Vol. 47 Issue 3 Pg. 264-5 (Mar 2009) ISSN: 1362-4393 [Print] England
PMID18594552 (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)

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