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Thread: Help with Autonomic Dysreflexia

  1. #1
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    Help with Autonomic Dysreflexia

    My son is a C4 complete. He is straight cathed every 6 hrs. Lately, every time I cath him he experiences Autonomic Dysreflexia. Pressure goes up to 150/120 + or - a few. Also, every night when I give him his suppository, BP shoots up. Have had to use Nitro paste to bring down. Normal BP is 105/60 or so. Took him to Dr., has a UTI. Put him on Cipro. Dr. also prescribed Hytin for BP. I haven't given him this yet because I feel it's not a "maintenance" problem as it only happens when he is cathed, having a foley put in, or a suppository given. His SCI was almost 4 years ago and this is the first we are having any problem with AD. I'm not convinced the Hytin is the answer. His normal BP is pretty low, so how low will it be on the Hytin? Any ideas on what may be causing this? ( I'm going on 1 week now of up and down BP & it's taking a toll on me!) All thoughts and ideas would be greatly appreciated!
    Sue

  2. #2
    Is his PCP an expert in SCI care (usually a physiatrist)? It does not sound like he knows much about AD. I would strongly recommend that you download, print, and take a copy of the clinical practice guideline on Management of Autonomic Dysreflexia from the Consortium for Spinal Cord Medicine. Insist that he read it and get familiar with appropriate management and prevention of AD. Keep a copy for yourself, and also download the consumer version.

    Did he actually have a UTI (fever, chills, malaise, etc.) or just a positive urine culture? The latter should rarely be treated with antibiotics. If he had a true febrile UTI, was Cipro selected on the basis of a culture and sensitivity test of his urine, or just a UA?

    Hytrin is both an antihypertensive and a drug used for BPH. How old is your son? Does he have an enlarged prostate? How much does he cath for when you do his catheterizations? What type of catheter do you use? Every 6 hours is stretching it for most people, and he may have volumes that are too high. When did he last have urodynamics? Does he have a good urologist who knows neurologic urology?

    While it is common for those with higher injuries to have more severe problems with AD, I would be concerned that high bladder pressures may be causing mild AD that may not be causing severe symptoms until you add the additional painful stimulus of a catheterization. The body is more sensitive to other stimuli when it is already in AD.

    Some things that can help with the AD during caths may be the use of urethral 2% lidocaine jelly (easiest to use is Urojet) 5 minutes prior to the cath. This can also be used rectally (not the same tube) 5 minutes prior to suppository insertion, and can be used for the lubrication for digital stimulation.

    Other causes for AD that should be ruled out include fractures, pressure ulcers, and other internal organ problems.

    (KLD)

  3. #3
    Quote Originally Posted by SCI-Nurse
    Some things that can help with the AD during caths may be the use of urethral 2% lidocaine jelly (easiest to use is Urojet) 5 minutes prior to the cath. This can also be used rectally (not the same tube) 5 minutes prior to suppository insertion, and can be used for the lubrication for digital stimulation.
    I experience precisely the same kinds of AD you described, Sue392, and the use of lidocaine jelly, which SCI-Nurse describes above, works wonders. You should definitely look into it for your son. AD is miserable.
    "I'm lost. I'm no guide, but I'm by your side." - Pearl Jam

    "It decomposes, mendicant, therefore, truly, one calls this the world." -- Loka Sutta

  4. #4
    I have never taken my blood pressure after catheterizing, but I would imagine if I did I would find it slightly above normal.

    Once upon a time, I did my BP in bed but I started having problems with AD (200+ systolic) and switched to conducting my BP in a shower chair. My blood pressure still rises above what is normal, but it's only temporary and it does not result in severe AD.
    Last edited by Lewis; 08-13-2005 at 01:12 PM.
    C5 injury with partial C6 function on left.

  5. #5
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    KLD
    My son is 19 years old and does not have an enlarged prostate. As for the UTI, we went to the hospital Thurs. and they did blood, urine, KUB, and ultrasound on him. That's when I found out about the UTI, which I would have never suspected due to no fever.
    When I cath I get approx 300 each cath, some in his leg bag also. I use Rusch (?) self contained cath kits. We go on Monday for urodynamics. When I do 4 hr. cath, I get less. It seems to be only when I insert cath that the headache/bp + starts. I hope at that Mon. I will have more answers. I feel it's a bladder/kidney stone issue (stones are a BIG problem for him) as I have checked for nails, tight shoes, etc.
    The ultrasound did show stones but according to Doc nothing obstructing or that would cause problems. As for his Urologist, I thought he was good, but now am beginning to wonder. He is head of Urology at the hospital (not that that makes him perfect).
    I have to agree that I some of the medical people I dealt with Thurs. are unfamiliar with AD. When the pressure went up as I cathed him, the nurses were very "non chalant" about doing his BP (we were in the ER for about 10 hrs). Once I got hold of a machine, I did it myself. I must say the staff really disappointed me. My survey won't go back with happy faces or stars this time! Thanks for you input sofar, it is MUCH APPRECIATED.
    Sue

  6. #6
    Antibiotics should NOT be prescribed merely for the presence of bacteria in the urine for people with SCI. This is "normal" colonization. Use of antibiotics in the absence of fever, chills, malaise, etc.will ultimately result in many resistant strains of bacteria that cannot be treated by any antibiotics. Print this out too, and take it to his urologist.

    http://www.ahrq.gov/clinic/epcsums/utisumm.htm

    Stones MUST be removed or he will have recurrent UTIs over and over and no antibiotic will treat them. Stones can definately leave him in mild AD at all times. If they get larger, they can damage or even destroy a kidney. People with SCI have to be vigilent about preserving their kidney function for the long term.

    If he is cathing for 300 cc. every 6 hours he is only putting out 1200 cc. of urine daily. This is not nearly enough. He should be drinking more fluids. Overly concentrated urine is a major cause of stones. Most people should drink a minimum of 2000 cc. daily, and put out around 1500 cc. of urine minimum. 2.5 liters of fluids daily is better. This may require more frequent caths, but would actually be healthier for him. At his level, he also has to be concerned about lung mucous retention, and his secretions with be thicker and harder to cough up if he is dehydrated.

    Ask his urologist about special training in neurologic urology. If he has none, you may want to look elsewhere. Since you are in NJ, I could recommend Todd Linnsenmeyer, MD without reservation.

    (KLD)

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