Autonomic Dysreflexia (AD)

Autonomic dysreflexia (AD), also known as hyperreflexia, results from the nervous system over-reacting to pain or discomfort.

Patients with a spinal cord injury above level T7 are at risk for autonomic dysreflexia.

AD can start quickly and is considered a life-threatening medical emergency.

AD can be caused by something painful or uncomfortable. Common causes may include:

  • Constipation or full bowel
  • Over filling of the bladder
  • Uncomfortable or tight fitting clothing
  • Pressure on skin from braces, splints or casts
  • Menstrual cramping
  • High blood pressure
  • Pounding headache (typically frontal)
  • Goose bumps
  • Sweating above the level of injury
  • Stuffy nose
  • Slow pulse or rapid pulse
  • Blotching of the skin (above injury level)
  • Restlessness
  • Flushed face
  • Red blotches on skin above the injury level
  • A feeling like something is wrong / anxious feeling or apprehensive
  • Elevated or below normal heart rate

If symptoms continue, call 911 as this is a medical emergency. Without treatment, stroke or death can occur. 

  • Raise the head of bed to 90 degrees (lowers blood pressure).
  • Assess bladder for fullness and cath if needed.
  • If AD occurs during bowel program, stop the program until AD is resolved. You can restart the bowel program once the symptoms go away.
  • Wear clothing that is comfortable and fits correctly.
  • Loosen your binder, if wearing one.
  • Remove splints if being worn.
  • Check the skin regularly for pressure areas, especially under casts, splints, braces.
  • Apply a numbing ointment to affected area.
  • Apply / take rescue medication at prescribed interval once AD begins (typically nifedipine or nitropaste). 
  • Continue a regular bowel program.
  • Follow cath schedule and any fluid restrictions prescribed.
  • Assess skin daily and at regular intervals.
  • Perform pressure relief every 20 minutes.
  • Eat a well-balanced diet.
  • Drink plenty of fluids.

Last Updated 04/2014