Key result
Abrupt cessation of a clonidine infusion in a 30-year-old man resulted in a severe sympathetic surge and acute pulmonary edema, which was reversed by restarting and slowly tapering the medication.
Case Report (n=1)
Abrupt withdrawal of clonidine infusion can cause a severe sympathetic surge leading to acute pulmonary edema, highlighting the need for slow downward titration.
May warrant gradual tapering of clonidine infusions; leaves open the incidence and optimal protocols.
A 30-year-old man with a history of epilepsy and substance misuse presented to the hospital with status epilepticus. Difficult seizure control necessitated anaesthetising the patient followed by intubation and ventilation. A clonidine infusion was started as the patient developed withdrawal syndrome and was difficult to wean off mechanical ventilation. Once the withdrawal syndrome was controlled, the clonidine was abruptly stopped. Two hours after stopping the infusion, the patient developed high-grade fever, severe hypertension, tachycardia, profound sweating and lacrimation. The patient then developed respiratory distress syndrome secondary to acute pulmonary oedema. Clonidine withdrawal as a cause of such response was proposed. Reversal of symptoms and successful reweaning was achieved by restarting a low-dose clonidine infusion followed by slow downward titration and use of oral clonidine as a step-down measure. The patient was subsequently discharged from the intensive care unit.
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Shaw et al. (2015) conducted a case report in Clonidine withdrawal syndrome (n=1). Abrupt clonidine withdrawal was evaluated on Sympathetic surge and acute pulmonary oedema. Abrupt cessation of a clonidine infusion in a 30-year-old man resulted in a severe sympathetic surge and acute pulmonary edema, which was reversed by restarting and slowly tapering the medication.
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