Autonomic neuropathy in a diabetic patient with renal failure

Abstract

This report concerns three episodes of rapidly progressing bradycardia and hypotension that occurred in a diabetic patient who had renal failure. These episodes occurred suddenly and unexpectedly, and were unresponsive to iv atropine or usual doses of ephedrine, ultimately requiring epinephrine and/or external cardiac massage for resuscitation. The cardiovascular reflexes of the patient were examined after discharge: beat-to-beat heart rate variation was minimal during both deep breathing and the Valsalva maneuver; the hand grip test was abnormal, and marked postural hypotension was present.