Autonomic Dysreflexia

Have you ever noticed a quadriplegic or paraplegic sweating profusely on an icy winter’s day and wondered what was going on? Perhaps you have seen one of our residents with goosebumps on their arms on a sweltering day in summer and thought it strange? Well, the examples above are not strange for people who have experienced catastrophic spinal cord injuries, but rather life-threatening. Yes, in quadriplegics and paraplegics with an injury at level T6 and above sweating and goosebumps are not signs of being hot or cold, but rather that they are experiencing an episode of autonomic dysreflexia.

Autonomic Dysreflexia or AD is a reaction of the autonomic (involuntary) nervous system to overstimulation. AD can be triggered by a bladder infection, blocked catheter, bowel obstruction, pressure sore or too much pressure on a part of the body, kidney/bladder stones, ingrown toenails or anything else that is causing the body extreme pain and/or discomfort. Once the cause of the discomfort/pain is treated or removed, the AD episode will end, although there may be a residual headache for a few hours or even days.

During an episode of AD the person’s blood pressure rises dramatically and often results in a pounding headache. Sweating, goosebumps, flushing of the skin, a slow heart rate, nasal stuffiness and anxiety are other common indicators that a person is in AD. AD is not just uncomfortable or an inconvenience, it can be life-threatening and needs to be treated immediately. So, if you ever see a resident at our Centre, don’t ask him if he is hot or cold, rather ask what is wrong.

TREATMENT
* Sit the individual up
* If you can lower their legs, do so
* Loosen any constrictive clothing
* Survey the individual for causes
* Catheterise the individual
* Use of a short-acting antihypertensive agent is recommended when the systolic blood pressure is at or above 150mm Hg
* Monitor blood pressure and pulse every 2-5 minutes until the individual is stablised
* Monitor the individual’s symptoms and blood pressure for at least 2 hours after resolution of the autonomic dysreflexia episode to ensure that elevation of blood pressure does not recur.