Hypersensitivity to administered adrenaline in tetraplegia.

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.