Adenosine and numbness

Q: A 47-year-old male in the ICU went into supraventricular tachycardia (SVT) and was successfully converted to Normal Sinus Rhythm (NSR) with a total of 18 mg of Adenosine. On the telemetry strip, total Asystole time was 8 seconds. The patient now complains of numbness in the upper extremities. What should be your next step? - select one

A) Repeat EKG 

B) CT scan of the head

C) Limited EEG

D) MRI

E) Observation

Answer: E 

Adenosine may make patients' limbs feel numb for a few minutes after administration intravenously. Usually, it happens when the patient requires more than 12 mg of Adenosine. It usually resolves without any complication.

There may be concern for some central effect, but it would be appropriate to observe rather than indulging in a 'million-dollar' workup (choices B, C, and D).

EKG (choice A) can be performed to confirm NSR and rule out underlying coronary ischemia, but observation precedes any workup.

#cardiology 

#pharmacology 

References/further reading: 

1. Gupta A, Lokhandwala Y, Rai N, Malviya A. Adenosine-A drug with myriad utility in the diagnosis and treatment of arrhythmias. J Arrhythm. 2020 Dec 18;37(1):103-112. doi: 10.1002/joa3.12453. PMID: 33664892; PMCID: PMC7896475.

2. Biaggioni I, Killian TJ, Mosqueda-Garcia R, Robertson RM, Robertson D. Adenosine increases sympathetic nerve traffic in humans. Circulation. 1991 May;83(5):1668-75. doi: 10.1161/01.cir.83.5.1668. PMID: 2022024.

3. Rae CP, Mansfield MD, Dryden C, Kinsella J. Analgesic effect of adenosine on ischaemic pain in human volunteers. Br J Anaesth. 1999 Mar;82(3):427-8. doi: 10.1093/bja/82.3.427. PMID: 10434828.