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 ·

Causes of AD:

– 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.

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.

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