Adrenergic storm

Adrenergic storm
Other namesSympathomimetic toxicity
Sympathomimetic toxidrome
ComplicationsTachycardia, hypertension
CausesCocaine, stimulant abuse, subarachnoid hemorrhage, methamphetamine, foods high in tyramine, rabies
Treatmentdiazepam, benzodiazepines, beta blockers, anti-hypertensives

An adrenergic storm is a sudden and dramatic increase in serum levels of the catecholamines adrenaline and noradrenaline (also known as epinephrine and norepinephrine respectively), with a less significant increase in dopamine transmission. It is a life-threatening condition because of extreme tachycardia and hypertension, and is especially dire for those with prior heart problems. If treatment is prompt, prognosis is good; typically large amounts of diazepam or other benzodiazepines are administered alongside beta blockers. Beta blockers are contraindicated in some patients, so other anti-hypertensive medication such as clonidine may be used.[1] Antipsychotics are also used to treat the most severe psychiatric reactions such as psychosis, paranoia or terror, after their use was formerly discouraged because of their potential to prolong the QT interval; however, more recent research performed since 2019 has revealed that this and other severe side effects are rare and their occurrence does not warrant banning antipsychotics from the treatment of adrenergic crises for which they can be extremely useful.[2][3][4][5][6][7][8]

Adrenergic storms are usually caused by overdoses of stimulants, especially cocaine or methamphetamine, or eating foods high in tyramine while taking monoamine oxidase inhibitors.[9] A subarachnoid hemorrhage can also cause an adrenergic storm.[9] A catecholamine storm is part of the normal course of rabies infection, and is responsible for the severe feelings of agitation, terror, and dysautonomia present in the pre-coma stage of the disease.[10]

  1. ^ King, Andrew; Dimovska, Mirjana; Bisoski, Luke (January 2018). "Sympathomimetic Toxidromes and Other Pharmacological Causes of Acute Hypertension". Current Hypertension Reports. 20 (1): 8. doi:10.1007/s11906-018-0807-9. PMID 29478133. S2CID 3530495.
  2. ^ Cite error: The named reference Malashock was invoked but never defined (see the help page).
  3. ^ Cite error: The named reference Connors was invoked but never defined (see the help page).
  4. ^ Richards, John R.; Derlet, Robert W. (December 2019). "Another dogma dispelled? Antipsychotic treatment of sympathomimetic toxicity". The American Journal of Emergency Medicine. 37 (12): 2256–2257. doi:10.1016/j.ajem.2019.05.013. PMID 31088749. S2CID 155090660.
  5. ^ Goldstein, Scott; Richards, John R. (1 January 2020). Richards, John R. (ed.). Sympathomimetic Toxicity. Treasure Island, Florida, United States of America: StatPearls Publishing. PMID 28613508. Retrieved 28 July 2021 – via NCBI (National Center for Biotechnology Information)/NLM (United States National Library of Medicine).
  6. ^ Connors, Nicholas J.; Alsakha, Ahmed; Larocque, Alexandre; Hoffman, Robert S.; Landry, Tara; Gosselin, Sophie (December 2019). "Evidence over dogma and anecdotes". The American Journal of Emergency Medicine. 37 (12): 2257. doi:10.1016/j.ajem.2019.05.014. PMID 31128936. S2CID 167206288.
  7. ^ Lam, Vivian; Shaffer, Robert W. (2017). "8. Management of Sympathomimetic Overdose Including Designer Drugs". In Hyzy, Robert C.; McSparron, Jakob (eds.). Evidence-Based Critical Care: A Case Study Approach (2nd ed.). Cham, Switzerland: Springer Nature. p. 65. doi:10.1007/978-3-030-26710-0. ISBN 978-3030267094. S2CID 202810365 – via Google Books.
  8. ^ Roberts, James R. (1 January 2016). Roberts, James R.; Hoffman, Lisa; Nace, Lynn; Gibson, Grace (eds.). "InFocus: Treating Sympathomimetic Toxicity". Emergency Medicine News. 38 (1). Wolters Kluwer Health, Inc. (Lippincott Williams & Wilkins): 10–12. doi:10.1097/01.EEM.0000476273.56614.28. Archived from the original on 10 January 2016. Retrieved 28 July 2021.
  9. ^ a b Cite error: The named reference :0 was invoked but never defined (see the help page).
  10. ^ Holstege, Christopher P.; Borek, Heather A. (October 2012). "Toxidromes". Critical Care Clinics. 28 (4): 479–498. doi:10.1016/j.ccc.2012.07.008. PMID 22998986.