What are the symptoms of an adrenaline crash?

Symptoms of an Adrenaline Crash

An adrenaline crash presents with symptoms of fatigue, weakness, hypotension, bradycardia, dizziness, and altered mental status as the body experiences a rapid decline in circulating epinephrine levels after a surge. 1

Common Symptoms

• Cardiovascular symptoms:

  • Hypotension (low blood pressure) 1, 2
  • Bradycardia (slow heart rate) or relative bradycardia (falling heart rate despite hypotension) 2
  • Weak pulse 1
  • Dizziness or lightheadedness 1
  • Syncope (fainting) or near-syncope 1

• Neurological symptoms:

  • Altered mental status or confusion 1, 3
  • Headache 1
  • Sense of impending doom 1
  • Fatigue or weakness 1
  • Tunnel vision 1

• Gastrointestinal symptoms:

  • Nausea 1, 2
  • Vomiting 1, 2
  • Abdominal cramping 1
  • Diarrhea 1

• Other symptoms:

  • Diaphoresis (excessive sweating) 1, 2
  • Pallor (pale skin) 1
  • Tremors (as epinephrine levels fluctuate) 1
  • Anxiety 1
  • Cool, clammy skin 1

Differentiating Features

• Unlike anaphylaxis, an adrenaline crash typically does not present with urticaria (hives), angioedema, or respiratory symptoms such as wheezing or stridor 1
• The skin is typically cool and pale in an adrenaline crash, whereas in anaphylaxis, flushing and warmth are more common 1
• Bradycardia is characteristic of an adrenaline crash, while tachycardia is more typical in anaphylaxis 1

High-Risk Situations

• Previous administration of epinephrine for anaphylaxis treatment 1
• Adrenal insufficiency (such as in Addison's disease) 4
• Rapid discontinuation of exogenous catecholamines 1
• Iatrogenic epinephrine overdose followed by rapid clearance 5
• Severe stress followed by a period of rest 3

Clinical Course

• Symptoms typically develop within minutes to hours after the triggering event 1
• The duration can vary from minutes to several hours depending on the cause and individual factors 1
• In severe cases, if untreated, it can progress to cardiovascular collapse and shock 2, 1

Warning Signs of Severe Adrenaline Crash

• Profound hypotension unresponsive to position change 2
• Altered consciousness or confusion 1, 3
• Severe bradycardia 3
• Signs of poor peripheral perfusion (delayed capillary refill) 1
• Collapse 1

Management Considerations

• Place patient in supine position with legs elevated to improve venous return 2, 1
• Avoid upright posture as it can worsen hypotension 2
• Monitor vital signs, particularly blood pressure and heart rate 3
• Consider fluid resuscitation for hypotension 2
• For severe bradycardia with hemodynamic compromise, atropine may be considered 3

Remember that an adrenaline crash can mimic other conditions such as vasovagal reactions, so careful assessment of the clinical context and preceding events is essential for accurate diagnosis 1.