Autonomic Dysreflexia (AD)


Autonomic dysreflexia (AD) Is a sudden increase in blood pressure, 20-40 mm Hg systolic higher than usual, caused by an injury, pain or anything harmful below the neurologic levels in a person with a SCI (spinal cord injury) This is a condition that happens with people that have an injury level T6 and above. If untreated it can lead to a stroke, seizures and even death.


The following are treatment recommendations that can be used for adults with Autonomic Dysreflexia (AD)

– Sit patient upright (90 degrees)
– Monitor BP every 2-3 minutes
– Quick exam to include abdominum for distended bladder/bowel and any other organ system below the level of injury that can be the source of dysreflexia.
– If an indwelling urinary catheter is not in place, catheterize the individual. If indwelling catheter is in place, check system for kinks, folds, constrictions, or obstructions.
– If systolic BP is over 150, give an antihypertensive with rapid onset and short duration while causes of AD are being investigated.
– Nitro Paste—1″, apply every 30 minutes, topically above level of injury, wipe off when BP is stable, reapply as needed.
*Hold if patient has taken PDE5 inhibitors (i.e. Viagra, Cialis, ect) within 24 hours.
– Nifedipine IR (if no nitro paste available) —10mg per dose, sublingual form or chewed, May repeat every 20 – 30 minutes as needed.
– IV Antihypertensives— only in monitored setting (ICU)
– Monitor symptoms and BP for at least 2 hours after the resolution of an AD episode.
– AD can lead to seizures, stroke or even death.

Common Causes

– Distended bladder

– Constipated bowel

– Pressure ulcers

-Fractured bones

– Skin burns

– Urinary tract infections

– Ingrown toenails

– Any condition or procedures that may cause pain or discomfort but is located below the neurologic level of injury.

What To Do:

– Sit up – Try to raise head to 90 degrees  (Stay sitting upright until the pressure is normal)

– Check blood pressure – Monitor your blood pressure every 5 minutes

– Check Bladder – Make sure your bladder is empty. For indwelling catheter  check for kinks or blockages

– Check bowel – You may have impacted stool or bowel blockage

– Check skin – Examine your skin for any wounds, burns, pressure ulcers,  cuts, or anything causing discomfort

– Take off – loosen or take off any tight or restrictive clothing or accessories

– Find other source – Assess for any other possible source of harmful/painful  stimuli or irritant if symptoms have not resolved

– Find help – If you are not able to properly resolve the symptoms on your own,  call your doctor for further assistance or go to the nearest emergency room 

Signs & Symtoms


– Hypertension (a fast increase in blood pressure, 20–40 mm Hg systolic higher than usual)

– A slower or faster heart rate than normal

– Pounding or “throbbing” Headache

– Sweating

– Goosebumps 

– Flushed skin

– Tingling sensation

– Changes in vision

– Nasal congestion

– Apprehension/anxiety/uneasy feeling


– Nausea

– Chills without a fever

– Pale

– Clammy