title: Hypersensitivity to administered adrenaline in tetraplegia.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  To describe two clinical examples of denervation hypersensitivity, an enhanced response to catecholamines demonstrated experimentally in tetraplegic patients.
  
  
  METHODS
  USA.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Because of denervation hypersensitivity, effective treatment of a cardiac arrest in tetraplegic patients may require a reduced dose of adrenaline.
authors.affiliation: Research Service, Boston Healthcare Center and Department of Medicine, Harvard Medical School, Boston, MA, USA. jfrisbie@comcast.net
authors.forename: J H
authors.initials: JH
authors.lastname: Frisbie
mesh_terms: D004837:Epinephrine / Q000009:adverse effects*; D006323:Heart Arrest / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011782:Quadriplegia / Q000188:drug therapy; D014662:Vasoconstrictor Agents / Q000009:adverse effects*; D014693:Ventricular Fibrillation / Q000139:chemically induced*
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine