The blood pressure in paraplegia I

2006

Section: Discussionsupporting

confidence: 60%

Unstable baseline blood pressure in chronic tetraplegia

2006

“…11 The highest risk group for PH consisted, not surprisingly, of those with the greatest neurological de®cit, tetraplegia and a motor complete grade of paralysis. The typical traumatic myelopathy consisting of central necrosis, the more extensive neurological de®cit suggests a greater chance of cord damage extending to the intermediolateral columns, the sympathetic tracts.…”

Section: Discussionmentioning

confidence: 99%

Postural hypotension and abnormalities of salt and water metabolism in myelopathy patients

Steele

1997

To describe the clinical manifestations of postural hypotension (PH) in myelopathy patients a standardized interview and chart review were carried out. Of 232 myelopathy patients with more than 2 years of paralysis seen during a 2 year period, 30 had been treated for PH. All PH patients were paralysed at levels higher than thoracic 7. The highest risk patients were tetraplegic, motor complete, 24 of 73 (33%). The common symptoms of PH were those of reduced consciousness (100%), strength (75%), vision (56%) and breath (53%). Precipitating factors were hot weather (77%) bowel care (33%) and meals (30%). Symptoms worsened with the duration of paralysis in 12 patients. Chronic hyponatremia was found in 54% of the PH patients and 16% of those without, P50.001. Of ®ve PH-hyponatremic patients with urine sodium and osmolality determinations, ®ve continued to retain water (4150 mOsm/kg) while four failed to conserve salt (419 mmol Na/L). PH is common among myelopathy patients with higher levels of paralysis, symptoms are variable, and abnormal salt and water metabolism often coexist.

“…11,12 The lowering of BP coincides with the loss of vital capacity as the level of paralysis becomes higher. 3,10,13 Second, this somatic disability also inacti- vates the assistance of leg muscle contraction in the return of venous blood from the lower extremities. 14 Third, although the centrally disabled sympathetic system reacts by reflex to noxious stimuli with autonomic dysreflexia, it fails to respond to orthostasis with vasoconstriction to protect the circulation against gravity.…”

Section: Discussionmentioning

confidence: 99%

“…2 Still another effect of higher levels of paralysis is diminished blood pressure (BP). 3 It is asked, therefore, whether a syndrome of hypotension, polydypsia, and hyponatremia at higher levels of paralysis can be demonstrated in a single cohort and whether it can be explained.…”

Section: Introductionmentioning

confidence: 99%

Salt wasting, hypotension, polydipsia, and hyponatremia and the level of spinal cord injury

2006

Study Design: Case control. Objective: To test the reported correlation of hypotension, polydipsia, and hyponatremia with higher levels of spinal cord injury (SCI). Setting: A Veterans Administration Hospital, USA. Methods: The records of men who were paralyzed owing to trauma at any spinal cord level with motor complete lesions (ASIA A or B) and who received an annual physical and laboratory examination were reviewed for age, duration of paralysis, level of paralysis, blood pressure (BP), serum sodium, and 24 h urinary volume, creatinine, and sodium. Creatinine clearance and fractional excretion of sodium (FcNa) were calculated. Spearman rank-order correlations (r s ) were carried out. Results: Patients were aged 25 to 88 years, median 56 years, paralyzed 2-61 years, median 26 years, with levels of paralysis ranging from C2 to L4, median T4, n ¼ 111. From lower to higher levels of paralysis FcNa increased (0.4-7.3%), mean BP diminished (132-66 mmHg), urine volume increased (600-5400 ml), and serum sodium was reduced (148-129 mEq/l) -r s ¼ 0.29, 0.49, À0.22, and 0.23, respectively. Increasing 24 h urinary volumes correlated with lower serum sodium concentrations but higher creatinine clearance, r s ¼ À0.28, 0.24. Increasing 24 h urinary sodium improved creatinine clearance, r s ¼ 0.37. P-values ranged from o0.05 to o0.001. Conclusion: Higher levels of SCI correlate with reduced sodium conservation, hypotension, polydipsia, and hyponatremia. Greater water intake raises creatinine clearance but lowers serum sodium. Greater salt intake increases creatinine clearance.