Abstract
BackgroundArginine vasopressin has been used for the management of refractory vasodilatory shock. However, it is still unclear whether arginine vasopressin is useful for hypotension in patients with spinal cord injury.Case descriptionA 78-year-old man with autonomic dysreflexia and paralysis below the level corresponding to Th2 due to spinal cord injury previously underwent cholecystectomy. During the surgery, accidental hemorrhage led him to refractory hemorrhagic shock unresponsive to fluid resuscitation and catecholamine. Lasting hypotension was improved with arginine vasopressin.ConclusionWe described a rare case report on the use of arginine vasopressin for management of refractory hemorrhagic shock in a patient with autonomic dysreflexia.
Highlights
BackgroundProlonged hypotension due to marked hemorrhage often progresses to shock that is unresponsive to fluid resuscitation and catecholamines such as norepinephrine [1,2,3]
Arginine vasopressin has been used for the management of refractory vasodilatory shock
There are no reports on the use of arginine vasopressin (AVP) for the refractory hemorrhagic shock in patients with autonomic dysreflexia caused by spinal cord injury
Summary
Prolonged hypotension due to marked hemorrhage often progresses to shock that is unresponsive to fluid resuscitation and catecholamines such as norepinephrine [1,2,3]. There are no reports on the use of AVP for the refractory hemorrhagic shock in patients with autonomic dysreflexia caused by spinal cord injury. We describe a case of catecholamine-resistant hemorrhagic shock treated by AVP in a patient with autonomic dysreflexia caused by spinal cord injury. Phenylephrine and epinephrine bolus, and continuous infusion of norepinephrine (0.1 μg/kg/min) were performed in order to maintain systolic blood pressure > 70 mmHg, a threshold for increased mortality in patients with hemorrhagic shock [11]. The SBP and MAP increased to 110 and 85 mmHg respectively, and the HR was 90 bpm His arterial blood pressure was maintained with 0.02 U/kg/h of AVP and 0.02 μg/kg/min of norepinephrine at the end of the operation. He had no prolonged hypotension and no neurological complication after surgery
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