Enteral and intranasal treatment for vasopressor-dependent hypotension in C1 tetraplegia

A complete traumatic C1 spinal cord lesion leads to bradycardia and temporary hypotension until fluid administration can restore blood volume and pressure to the autosympathectomized capacitance vessels. In spite of adequate volume status, however, our patient required intravenous pressor agents to maintain adequate arterial and central venous pressure several weeks after injury. Using oral pseudoephedrine and occasional nasal phenylephrine, intravenous lines could be removed with maintenance of arterial pressure and resolution of bradycardia.