adrenergic storm

see also:

• sympathomimetics

• an adrenergic storm is a potentially life threatening sudden increase in serum levels of the catecholamines, mainly, epinephrine and norepinephrine
• see also sudden transient surges in BP

• cocaine overdose
• metamphetamine / meth / ice overdose
• septic shock
• monoamine oxidase inhibitors (MAOIs)
• phaeochromocytoma
  • at induction of anaesthesia
  • on squeezing the tumour in surgery, or during straining, labour, fetal movements, etc
• neuroblastoma
• subarachnoid haemorrhage (SAH)
• rabies and related lyssaviruses

• panic attack
• thyroid storm
• serotonin syndrome
• malignant hyperthermia

• tachycardia
• hypertension
• anxiety
• tachypnoea
• hyperkinetic movements
• possible hyperthermia, mania, delirium, cardiac arrhythmias, rhabdomyolysis, stroke (CVA), acute myocardial infarction (AMI/STEMI/NSTEMI), catecholamine induced cardiomyopathy

• treat the cause where possible
• cardiac monitor
• IV fluids
• supportive care
• benzodiazepines but avoid alprazolam as it weakly agonizes dopamine receptors and causes catecholamine release
• beta adrenergic blockers - non-selective beta blocker but avoid propranolol as it mildly promotes some catecholamine release - each worsening the condition
• antipsychotics if needed