Which triggers are common for autonomic dysreflexia in spinal cord injury patients above T6, and what is the initial management?

• A. Stimuli such as bladder distension and painful stimuli, with initial treatment to sit upright, remove triggers, and control blood pressure per protocol.
• B. Triggers include low blood sugar; treat by lying down and giving sugar.
• C. Dysreflexia is self-limiting; no treatment needed.
• D. Triggers are irrelevant; treat with immediate surgery.

Answer: (B)

Autonomic dysreflexia occurs in people with spinal cord injuries above T6 when a noxious or sensory stimulus below the level of injury triggers a sudden, unregulated surge of sympathetic activity, leading to a dangerous rise in blood pressure. Common triggers are bladder distension from urinary retention and other stimuli such as bowel impaction, tight clothing, or painful procedures. The initial management is to sit the patient upright to use gravity to lower blood pressure, promptly identify and remove the triggering stimulus (for example, ensure the bladder is drained with catheterization and assess for bowel impaction), and monitor blood pressure frequently. If hypertension persists after removing triggers, follow clinical protocol for rapid BP reduction while continuing to address the inciting causes. The idea that a low blood sugar trigger would cause dysreflexia and that treatment would be lying down with sugar does not fit this condition.