Hypercapnia Caused by a Therapeutic Dosage of Pregabalin in a Tetraplegic Patient With Cervical Spinal Cord Injury.
Pregabalin is often used for the treatment of neuropathic pain in patients with spinal cord injury (SCI). We reported a patient with C5 [S(C5/C6)] ASIA Impairment Scale C SCI due to cervical myelopathy who presented CO2 retention when taking a therapeutic dosage of pregabalin. An 88-year-old patient with cervical SCI was transferred to the department of physical medicine and rehabilitation. When he had transferred, his neuropathic pain had been treated with 150-mg pregabalin per day (75 mg twice a day); however, he still exhibited severe neuropathic pain with a Numeric Pain Rating Scale score of 7 to 8. Dosage for the pregabalin increased from 150 mg/d (75 mg twice a day) to 225 mg/d (150 mg at morning and 75 mg at dinner). That afternoon, he presented drowsiness and confusion, and arterial blood gas analysis (ABGA) demonstrated respiratory acidosis with CO2 retention; pH, 7.312; PaCO2, 62.8 mm Hg; PaO2,58.9 mm Hg; HCO3 concentration, 30.8 mmol/L; base excess, 3.2 mmol/L; and oxygen saturation, 90.4%. Finally, he required tracheal intubation and ventilation. After 6 weeks, the patient was transferred to a general ward, and the follow-up ABGA and end-tidal CO2 showed normal range with the discontinuation of pregabalin. We demonstrated CO2 retention via ABGA in a patient with SCI due to cervical myelopathy who developed hypercapnia after taking a therapeutic dose of pregabalin. Physicians should pay particular attention to CO2 retention when prescribing a therapeutic dosage of pregabalin in a patient with cervical SCI.
From the Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea (KHD, EJC, H-EY); and Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Korea (MCC).
Kyung Hee
KH
Do
Eun Jung
EJ
Choi
Min Cheol
MC
Chang
Hea-Eun
HE
Yang
D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000293:injuries; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D006801:Humans; D006935:Hypercapnia / Q000139:chemically induced* / Q000503:physiopathology; D008297:Male; D009437:Neuralgia / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D010147:Pain Measurement; D000069583:Pregabalin / Q000009:adverse effects* / Q000627:therapeutic use; D011782:Quadriplegia / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D012129:Respiratory Function Tests; D018570:Risk Assessment; D013119:Spinal Cord Injuries / Q000150:complications* / Q000175:diagnosis; D016896:Treatment Outcome
D000069583:Pregabalin