Management of autonomic dysreflexia
Manage a problem ‘just-in-time’
Serious complications can arise if autonomic dysreflexia is not managed in a timely way and/or occurs repeatedly.
You could experience:
- Changes in the brain’s electrical activity, which can cause fits or seizures.
- Bleeding in the retina, the light sensitive tissue of the eye, causing severe vision impairment (retinal haemorrhage).
- Excess fluid in the lungs called pulmonary oedema.
- Organ damage:
- Heart attack, which can lead to heart failure.
- Poor functioning of the kidneys (renal insufficiency), which can lead to kidney failure.
- A rupture or leak in a blood vessel in the brain, called cerebral haemorrhage.
- Death.
‘Just-in-time’, or the right care at the right place at the right time, will reduce risk and prevent complications. As a result, you will maintain your quality of life, independence, health and wellbeing.
Be proactive and take responsibility for managing your own health risks
This involves:
- Learning to understand why autonomic dysreflexia occurs, what causes it and how to deal with it.
- Becoming a partner in decision-making with your doctor and other health professionals.
- Carrying an AD emergency treatment card in your wallet at all times.
- Developing an individual autonomic dysreflexia management plan.
- Engaging in ongoing health and wellness activities for preventing autonomic dysreflexia:
- Maintaining a healthy bladder function.
- Maintaining a healthy bowel function.
- Preventing other potential causes of autonomic dysreflexia.
- Knowing what to do when you have autonomic dysreflexia.
- Scheduling an annual check-up.
Managing an episode
Self-management tips
Immediate actions to be performed by yourself or a carer:
- Sit up, if lying down
- Loosen or remove any tight clothing
- Search for a cause (check your Bladder first), eliminate cause if possible
- Check blood pressure if possible
- Call a relative or a friend for help.
Actions if warning signs do not subside and/or blood pressure remains high
- Call the emergency number Triple Zero: Dial 000
- Keep looking for the cause/s
- Monitor your blood pressure every 5 minutes
- Take your prescribed medication/s. See next page for details.
What to do when your autonomic dysreflexia subsides?
Monitor for any re-occurrence.
Please note: You may be at risk of another episode in next 24-48 hours.What to do when problem still persists and blood pressure still remains high?
Call an ambulance.
Dial 000
Remember
Autonomic dysreflexia is most commonly triggered by a BLADDER or BOWEL cause. Check for kinks in catheter or blockage to flow or over-full leg bag.
Tight clothing
This commonly include abdominal binders, shoes or leg braces, leg bag strap, external catheter tape, clothes or elastic hose or bandages.
Medication
Check regularly for expiry dates.
Keep calm and call for help.
What does research tell you?
- An acute episode of autonomic dysreflexia can lead to an increased susceptibility to further episodes due to an excess of chemicals, called catecholamines, circulating in your blood. These chemicals make it more likely for autonomic dysreflexia to be triggered by stimuli like muscle stretches, bowel care or other activities that usually do not aggravate autonomic dysreflexia.
- Monitoring of your blood pressure for appropriately 48-72 hours after an episode of autonomic dysreflexia is recommended. During this time any medical procedures should be kept to a minimum.
Medications
Medications for treating autonomic dysreflexia
Before starting on any medication, always read the instructions and ensure this medication is safe to take with other medications. Check the dose and possible side effects, as well as the expiry date and contraindications.
Autonomic dysreflexia is commonly treated with two medications that can be self-administered:
- Glyceryl Trinitrate (GTN) is manufactured as a mouth spray, a chewable tablet and a skin patch. You need a prescription from your doctor.
- Other blood pressure medications. Captopril is manufactured as a chewable tablet. You need a prescription from your doctor.
How to take Glyceryl Trinitrate (GTN)
Spray
One spray under tongue
Dose: 400mcg per spray
Product name: Nitrolingual pump spray
OR
Tablet
OR
Patch
One patch on chest or arm
Dose: 5mg per 24 hours
Product name: GTN transdermal patch
Check blood pressure in 5 to 10 minutes
No effect or little effect
on your high blood pressure
OR
Low or normal
blood pressure
Spray
Second spray under tongue
Dose: 400mcg per spray
Spit out residual spray
OR
Tablet
Take other half tablet under tongue
Dose: 300mcg per tablet
Spit out residual tablet
OR
Patch
Do not remove the patch
Dose: 5mg per 24 hours
Remove the patch
Low or normal
blood pressure
Spray
Spit out residual spray
Tablet
Spit out residual tablet
Patch
Remove the patch
Be aware that up to 3 doses of spray or tablet can be given in 30 minutes.
Do not take GTN if you have used medications for erectile dysfunction, such as Sildenafil (Viagra), Vardenafil (Levitra) or Tadalafil (Cialis) in the last 3-4 days.
Do not take medications for erectile dysfunction, such as Sildenafil (Viagra), Vardenafil (Levitra) or Tadalafil (Cialis), within 24 hours after taking GTN.
How to take Captopril
Captopril will sometimes be prescribed instead of GTN because:
- GTN spray, tablets or patch are unavailable.
- You have used Viagra, Vardenafil or Cialis for erectile dysfunction within the last 3-4 days so you are not allowed to take GTN due to the risk of it lowering your blood pressure too much.
Tablet
Dose: 25mg per tablet
Brand name: Capoten
Takes about 3 minutes to dissolve
Check blood pressure in 15 minutes
No effect or little effect
on your high blood pressure
Low or normal
blood pressure
CALL an AMBULANCE
Dial 000
Spit out the residual tablet
Low or normal
blood pressure
Spit out the residual tablet
What does research tell you?
Nifedipine bite-and-swallow capsules, previously used for treating autonomic dysreflexia in Australia, are no longer available due to risks associated with use in people treated for other conditions, such as chest pain (angina) or high blood pressure (hypertension).
Recurrent autonomic dysreflexia
This refers to an episode of autonomic dysreflexia that recurs soon after an initial episode because the underlying cause has not been resolved, got worse or you may be more at risk.
After a severe and prolonged episode, certain activities that do not usually cause autonomic dysreflexia, e.g., muscle stretching or bowel care, can lead to symptoms.
How to self-manage recurrent autonomic dysreflexia
- Monitor your symptoms and blood pressure for at least 4 hours after resolution of the autonomic dysreflexia episode to ensure a rise in blood pressure does not recur.
- Autonomic dysreflexia may resolve due to taking medication, not because the underlying cause has been resolved. Recurrence may be expected if the underlying cause has not been correctly identified and resolved.
Frequent autonomic dysreflexia
- Regularly monitor your symptoms and know your baseline blood pressure.
- Autonomic dysreflexia may occur frequently because of an underlying cause.
- If you have frequent episodes of autonomic dysreflexia, consult with your doctor to investigate and rule out any underlying causes, which may include:
- Recurrent urinary tract infections
- Bladder and kidney stones
- Bowel constipation
- Other medical conditions.