Urinary Catecholamine Metabolite Concentrations in Tetanus

Toothill, C.; Dykes, J. R. W.; Ablett, J.J.L.

doi:10.1093/bja/42.6.524

Cited by 16 publications

(8 citation statements)

References 8 publications

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“…Concommitent with the correction of hemodynamic parameters, the extremities were noted to be warm and pink. SenJm and urinary catecholamine levels are known to be elevated in severe tetanus [3,4]. In our patient, suppression of sympathetic overactivity after fentanyl infusion was confirmed not only by the stability of blood pressure, but also by the concomitant decrease in plasma catecholamine levels and urinary catecholamine excretion.…”

Section: Case Historysupporting

confidence: 69%

Fentanyl Therapy Controls Autonomic Hyperactivity in Tetanus

Moughabghab

Prévost

Socolovsky

1997

J Intensive Care Med

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Section: Case Historysupporting

confidence: 69%

Fentanyl Therapy Controls Autonomic Hyperactivity in Tetanus

Moughabghab

Prévost

Socolovsky

1997

J Intensive Care Med

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“…This theory was based on the results of two studies. The first was Toothill's study of urinary catecholamine metabolites, which showed normetepinephrine to be greater than normal in two of 21 measurements, whereas all metepinephrine values were all within the normal range [7]. The second was Kelty's study using plasma samples from three subjects, which showed that norepinephrine accounted for the majority of catecholamines measured [18].…”

Section: Discussionmentioning

confidence: 99%

“…Elevated catecholamine concentrations in some patients were first reported over 30 years ago [6]. The most comprehensive study to‐date, by Toothill and Dykes in 1970 [7], failed to show any correlation between disease severity and catecholamine excretion. Chromatographic measurements revealed an elevation of normetepinephrine in two of the eight patients studied, of whom only one displayed signs of marked sympathetic overactivity.…”

mentioning

confidence: 99%

Urinary catecholamine excretion in tetanus

Thwaites¹,

Yen²,

Cordon³

et al. 2006

Anaesthesia

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Summary Imperfect understanding of the pathophysiology of tetanus has limited therapeutic advances. Autonomic disturbance is a major cause of mortality and is believed to be associated with catecholamine release, predominantly norepinephrine. We measured epinephrine and norepinephrine concentrations in 24‐h urine collections from tetanus and critically ill patients suffering from other severe diseases. In patients with severe tetanus, mean (SD) epinephrine was 164.18 (129.37) nmol.day−1 compared with 45.18 (37.74) nmol.day−1 in mild‐moderate disease (p = 0.008). In the severe group, mean (SD) norepinephrine was 411.64 (208.5), and 121.00 (81.81) nmol.day−1 in moderately ill patients (p < 0.001). Compared with critically ill control patients, median epinephrine was 331.77 in tetanus patients and 89.70 nmol.day−1 in controls (p < 0.001). Median norepinephrine concentration was 788.02 nmol.day−1 in tetanus and 300.05 nmol.day−1 in control patients, p = 0.006. The study finds a novel result of increased epinephrine excretion in tetanus and confirms that catecholamine excretion in tetanus exceeds that in other critically ill patients. These results should be considered in designing more effective therapeutic strategies.

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“…Urinary catecholamine metabolites (4-hydroxy 3-methoxymandelic acid and methylated catecholamines) concentration was also measured in 8 tetanus patients [50]. Although at some stage of their illness six of the eight cases showed elevated concentrations of catecholamine metabolites, these did not usually correlate with episodes either of cardiovascular instability or of hypertension.…”

Section: Catecholamine Levels In Patients With Tetanusmentioning

confidence: 99%

The involvement of the sympathetic nervous system in tetanus

1979

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Besides the characteristic disturbances of the motor nervous system symptoms indicating an overactivity of the sympathetic nervous system can complicate the course of severe cases of tetanus. These symptoms include fluctuating tachycardia and hypertension, electrocardiographic changes, sweating, constipation with development of paralytic ileus and metabolic disorders. These symptoms are comparable to these developing in patients with phaeochromocytoma. Elevated catecholamine levels in plasma and urine have been found in several patients with tetanus who developed these symptoms. The prolonged over-activity of the sympathetic nervous system is thought to contribute to the still considerably high mortality rate. Myocardial lesions observed at necropsy are comparable to those found in patients dying of phaeochromocytoma. These lesions are suggested to be associated with sudden death from arrhythmias or cardiac failure in patients with tetanus. For the protection of the organism against the overactivity of the sympathetic nervous system a treatment using the combination of beta-adrenergic receptor blocking agents and adrenergic neuron blocking agents has been introduced. A reduction of the mortality rate was achievable by this treatment. Experimental evidence is accumulating that the tetanus toxin affects not only the motor, but also the sympathetic and sensory neurons.

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Urinary Catecholamine Metabolite Concentrations in Tetanus

Cited by 16 publications

References 8 publications

Fentanyl Therapy Controls Autonomic Hyperactivity in Tetanus

Fentanyl Therapy Controls Autonomic Hyperactivity in Tetanus

Urinary catecholamine excretion in tetanus

The involvement of the sympathetic nervous system in tetanus

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