Arterial Spasm Due to Intravenous Infusion
Authors: M. Sutton
Journal: BMJ (1952)

may be restless, but in the later stages becomes weak and comatose.A mass is often palpable in the loin.Death may occur with dramatic suddenness.The three principal aspects for discussion are the cause of the haemorrhage, the cause of death, and the treatment.if any.Cause of the Haemorrhage.-Ithas been suggested that trauma during labour or delivery is the factor responsible for massive unilateral adrenal haemorrhage (Mitchell- Nelson, 1950).Cases in adults have been reported in which haemorrhagic cysts of the adrenal have followed trauma.However, it is difficult to understand how the adrenal glands, which are unusually well protected from external trauma, could suffer during normal labour or could be damaged during delivery without external signs of injury.Moreover, in our two cases delivery was quite straightforward.Venous thrombosis, a fairly common occurrence in the neonatal period, could be a causal factor, but cases of adrenal vein thrombosis without gross haemorrhage are not rare.Moreover, in Case 2 the adrenal veins were found to be empty.It is conceivable that massive haemorrhage into the adrenal gland could be part of the picture of haemor- rhagic disease in the newborn which may produce bleeding from one site only.Prothrombin estimations were not done in these cases, and no definite conclusion is possible con- cerning this suggested cause.A further possibility which several authors have entertained is that there is excessive degeneration of the foetal cortex.It would seem strange if this tendency were manifest on one side only; the adrenal gland on the opposite side in Case 2 appeared to be normal.Cause of Death.-Acuteadrenal insufficiency has been suggested as the immediate cause of death, but this seems to be unlikely.In the neonatal period the medullary and the chromaffin tissue are situated principally outside the adrenal gland, and the gland itself consists largely of invo- luting foetal cortex (von Reuss, 1920).Furthermore, Zuelzer (private communication) describes a case in which a child died when 8 days old, both adrenals having been destroyed by haemorrhage.He believes that the haemorrhage had occurred at birth, and that the child had lived for eight days virtually without adrenals.In the fatal cases so far reported the severity of the haemorrhage seems to have been a sufficient cause of death-particularly when there has been rupture of the haemorrhagic mass into the peritoneal cavity.M7he clinical picture is also in keeping with the diagnosis of severe internal bleeding.Treatment.-Mildcases in which the haemorrhage is self- limited will need no treatment-in fact, many will pass un- recognized.In others the bleeding is so rapid and profuse that the infant is dead before effective measures can be started.In cases of intermediate degree early recognition of the condition and the administration of blood transfusion may be life-saving.SunmaryTwo cases of unilateral neonatal haemorrhage of the adrenal gland are reported and the symptomatology is described.The aetiology of the haemorrhage and the cause of death are discussed.It seems probable that some of the more severe cases might be saved by early and vigorous efforts to deal with internal haemorrhage.