Hypotension in Tetanus

Corbett, J. L.; Spalding, J. M. K.; Harris, P

doi:10.1136/bmj.3.5877.423

Cited by 22 publications

(3 citation statements)

References 15 publications

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“…Inotropes are required for the treatment of various complications in patients with severe tetanus—autonomic instability, septic shock, and myocarditis. 9 17 18 These factors, in turn, are associated with increased mortality. Angurana et al too found inotrope use to be associated with mortality in tetanus ( p -value of 0.002).…”

Section: Discussionmentioning

confidence: 99%

Clinical Profile and Outcome of Pediatric Tetanus at a Tertiary Care Center

Mondkar

Tullu

Deshmukh

et al. 2020

J Pediatr Intensive Care

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The aims and objectives of this study are to study clinical profile and factors affecting mortality in tetanus. This was a retrospective study of 25 tetanus patients (aged 6 months–12 years) admitted to pediatric intensive care unit of a tertiary center (over 3 years). In this study, 25 tetanus cases (mean age 6.6 years) were analyzed; 16 were males and 9 were females. Incubation period ranged from 2 to 30 days (mean 8.2 days), period of onset from 11 to 120 hours (mean 42.8 hours), and duration of spasms from 4 to 26 days (mean 14 days). The commonest portal of entry was posttrauma (52%), followed by otogenic (40%). Eighteen patients had moderate and 7 had severe tetanus. Fifteen were unimmunized and 10 were partially immunized. The commonest complaints were trismus and spasms (100%), hypertonia (72%), fever (60%), dysphagia (48%), and neck stiffness (44%). Eight patients required primary tracheostomy and 11 required primary endotracheal intubation. Complications encountered were pneumonia (58%), conjunctivitis (41%), gastrointestinal bleed (37.5%), urinary infection (33%), acute kidney injury (AKI) following rhabdomyolysis (33%), sepsis (29%), disseminated intravascular coagulation (DIC) (25%), bedsores (25%), and acute respiratory distress syndrome (ARDS) (20%). Oral diazepam was most commonly used, followed by midazolam, vecuronium, and magnesium sulfate. Mortality rate was 32% (five moderate and three severe cases died). Short period of onset (less than 48 hours), AKI following rhabdomyolysis, sepsis, DIC, ARDS, and inotrope need were significantly associated with higher mortality. It is concluded that the commonest portal of entry was posttrauma. None of the patients was completely immunized. Short period of onset, AKI, sepsis, DIC, ARDS, and inotrope need predicted a higher mortality.

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Section: Discussionmentioning

confidence: 99%

Clinical Profile and Outcome of Pediatric Tetanus at a Tertiary Care Center

Mondkar

Tullu

Deshmukh

et al. 2020

J Pediatr Intensive Care

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“…On the other hand, episodes of profound hypotension lasting from minutes to hours without tachycardia were observed by Corbett et al [13]. The onset and end of such episodes was often abrupt and the hypotension was often produced in response to a stim-ulus.…”

Section: Cardiovascular Disturbancesmentioning

confidence: 94%

“…The onset and end of such episodes was often abrupt and the hypotension was often produced in response to a stim-ulus. The hypotension was not due to sustained sympathetic nervous overactivity, since small doses of noradrenaline produced a rise in blood pressure and heart rate in these patients, but may represent another effect of tetanus on autonomic nervous activity including impairment of baroreceptor reflexes [13]. A further patient who developed a phase of hypotension when sympathetic activity appeared minimal was described by Kerr et al [30].…”

Section: Cardiovascular Disturbancesmentioning

confidence: 95%

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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