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The Rollin' RN's

Autonomic Dysreflexia

Autonomic Dysreflexia (AD) is an abnormal overreaction of the involuntary (autonomic) nervous system to any irregular stimulation. Great definition and allow us to repeat…Abnormal and Overreactive. Two perfect words to describe this annoyance that can occur for many of us with a T6 level or higher spinal cord injury (SCI). AD sounds like the class bully, right? So, let us break down this topic into a short and easy to understand article for you.

Autonomic dysreflexia is a condition that emerges after a spinal cord injury, usually when the injury has occurred at or above the T6 level. You may hear, “But I’m a T8, and I experience it too,” and that is a possibility, but it is unlikely to occur if the level of injury is below T10. That said, autonomic dysreflexia develops in 20% to 70% of patients with spinal cord injury above the T6 level, but the T7-T10 level can be a gray area for AD for some. So, don’t breathe easy just yet if you fall in that gray area as you may experience this irregular stimulation also.

Symptoms of Autonomic Dysreflexia

The first signs of autonomic dysreflexia are usually a flushed feeling or a pounding headache. You also may have:

  • Heavy sweating

  • Anxiety

  • Slower heart rate

  • Elevating blood pressure

  • Blurry vision

  • Goosebumps

  • Difficulty in breathing

  • Stuffy nose

  • Confusion or anxiety

Causes for Autonomic Dysreflexia

Something as simple as a full bladder or an ingrown toenail can be enough to send your nerve responses into overdrive. Remember, anything that occurs below the level of SCI can cause AD.

Other things that can set off this condition include:

  • Constipation

  • Kidney stones

  • Urinary tract infection (UTI)

  • Inserting a catheter

  • Hemorrhoids

  • Irritated or blistered skin

  • Pressure sores

  • Sunburn or hot water burns

  • Pressure on the scrotum

  • Sexual stimulation

  • Menstrual cramps

  • Tight clothing

  • Post-op pain

  • Gallstones

  • Appendicitis

  • Pregnancy

Of Note: Urodynamic testing can and commonly produces AD symptoms. Patients at high risk for AD who are getting urodynamic testing should have continuous cardiovascular monitoring.

Treatment for Autonomic Dysreflexia

The noxious stimuli causing AD should be located and corrected as soon as possible. Bladder and bowel distension are the most common causes but, as the list above reveals, there are numerous other triggers, and the key is locating the culprit and correcting it quickly. If the cause is unable to be found and AD symptoms continue, consider calling 911 for additional monitoring. Autonomic dysreflexia can be a life-threatening condition if the cause is not corrected quickly.

Carry a card that explains AD like the one found here to educate those unfamiliar with this condition, especially in an emergency.

It’s all good, so keep on rollin’,

Patty, BSN, RNC and Roberta, RN

The Rollin’ RNs ™



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