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 °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.
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Acknowledgements
This study is the result of work supported with resources and the use of facilities at the Boston Healthcare Center, Boston, MA, USA.
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Frisbie, J. Hypersensitivity to administered adrenaline in tetraplegia. Spinal Cord 47, 264–265 (2009). https://doi.org/10.1038/sc.2008.84
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DOI: https://doi.org/10.1038/sc.2008.84
