Adrenaline

Adrenaline, also known as epinephrine, is a chemical, a neurotransmitter as well as a hormone generated by the adrenal glands present in numerous animals. In addition to several minor stimulations, the secretion of adrenaline in our body excites the heart beat and enlarges the blood vessels as well as the air channels. Normally, adrenaline is produced in intense anxiety or exciting conditions. In fact, the expression 'fight or flight' is frequently used to describe the conditions in which adrenaline is discharge into the body. In other words, adrenaline is the primary substance that enables the body's 'fight or flight' effect. In fact, adrenaline permits the body to encounter hazardous and unanticipated situations in a more effective manner. The enlarged blood vessels and air passages help the body to circulate more blood to the muscles and obtain more oxygen into the lungs and thereby enhance the physical performance temporarily.

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In the human body, adrenal glands are present right on top of the kidneys and are approximately three inches or 7.62 cm long and about 1.5 inches in height. When the adrenal glands are at work they also secrete norepinephrine, also known as noradrenaline. The adrenal glands release around 80 per cent adrenaline and 20 per cent norepinephrine in any hale and hearty human. Adrenaline results in constricting some of the smaller blood vessels, while widening the blood vessels in the liver and the skeletal muscles. In the process, adrenaline aids in a better blood flow towards the skeletal muscles and liver. This enables the muscles and liver to operate in their utmost ability to enhance the supply of oxygen to the vital organs in the body. Adrenaline is also responsible for disintegrating glycogen to glucose. This chemical transformation takes place in the liver and increases the sugar level in the blood. Like adrenaline, the noradrenaline also constricts blood vessels. The difference between the two is that the noradrenaline constricts almost all the blood vessels, while the adrenaline only constricts the less important ones. These two hormones also team up to enhance the quantity of free flowing fatty acids enabling the body to use them anytime it requires them.

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It may be noted here that adrenaline is the preferred cure for anaphylactic shock (a severe, rapid and at times fatal hypersensitivity reaction to a substance) and ought to be given instantaneously when an individual shows symptoms of severe allergic results. Natural as well as synthetic adrenaline shots are also administered to cure bronchial asthma, a severe allergy, and other conditions. The dosage of adrenaline should always be fixed by an authorized medical practitioner in advance and instructions ought to be offered regarding the place and time of administering the injection. The possibility of serious aftereffects such as gangrene cannot be ruled out in the event of the shot is administered in the incorrect place.

Although the word adrenaline is well accepted in the United States, the medical community prefers to refer it as epinephrine. The reason behind this preference is the move by a pharmaceutical firm to trade mark an analogous word 'adrenalin'. Nevertheless, most people in the United States use the words 'adrenaline' and 'epinephrine' in their speech at the same time and if anyone asked for an adrenaline injection, the medical practitioner will surely comprehend what is precisely being requested. It may be mentioned here that adrenaline or epinephrine is utilized as a medication to cure cardiac arrest. Owing to the suppressive upshot of adrenaline on the immune system, it is the preferred drug for treating anaphylaxis. It is also effective in treating sepsis (an acute ailment caused by devastating infection of the blood stream). Allergy patients undergoing immunotherapy can get an epinephrine wash before the allergen extract is administered, thereby reducing the immune reaction to the administered allergen.

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It is interesting to note that the first hormone to be recognized by the scientists is adrenaline and was successfully manufactured artificially way back in 1904. Adrenaline belongs to the family of biogenic amines that, among other things, comprises serotonin and histamine. The precise amalgam grouping is known as the catecholamine group that includes dopamine and norepinephrine. Constant high intensity of catecholamines in the blood is an excellent sign of incessant or unceasing strain.

The high levels of catecholamines in the blood is perhaps essential especially following a traumatic condition to 'sweat off' the adrenaline or epinephrine that has been discharged into an individual's system. In fact, our predecessors took care of this physically by way of fighting or additional hard work. However, in our contemporary times, severe stressful conditions take place frequently and these engage insufficient bodily movements. And when this happens, they may leave behind great quantities of adrenaline in our body. In most cases, the side effects of this are stressed out nerves and insomnia or sleep disturbances.

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Functions of adrenaline

Adrenaline or epinephrine is the most important catecholamine that is released from the adrenal medulla when it is stimulated and it has a vital role in any enhancement in alertness (neural activity), blood pressure and cardiac output. Adrenaline is actually a natural remedy for the harmful chemicals that are secreted by the body when one has serious allergic reactions, which are caused by food allergy, drug allergy or insect allergy. The effect of adrenaline is just opposite to that of insulin. In fact, it is considered to be the first messenger hormone and is released when the levels of glucose in the bloodstream are low. Adrenaline is a member of the adrenal medulla hormone family.

Adrenaline affects the glycogen and fatty acid storage as well as mobilization in a big way and equivalent metabolic conduits. Adrenaline is a sympathomimetic agent that works directly having an effect on alpha as well as beta adrenoreceptors. The main effects of adrenaline include augmented systolic blood pressure, decreased diastolic pressure, hyperglycemia, tachycardia and hypokalaemia. In addition, adrenaline is a potent stimulant for the cardiac system. It possesses vasopressor attributes, is a bronchodilator and has an antihistaminic effect. The action of adrenaline begins rapidly and continues for a brief period. It is believed that the action of adrenaline is primarily owing to the hormone's alpha agnostic action, intervening potent peripheral vasoconstriction, and enhanced diastolic aortic pressure. All these actions of adrenaline result in better blood circulation through the coronary artery.

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Adrenaline activates the cAMP cascade (also known as the adenylatcyclase cascade). Such stimulating cascade has an influence on the gathering together of glycogene (in the liver) as well as triacylglycerines (in the fat tissues) and results in an overall enhancement of the pace of metabolism. As a result of this there is a rise in the blood sugar levels, which facilitates the glucose fermentation in the muscles. Moreover, adrenaline strengthens these consequences, as it lessens glucagon secretion.

Usages and indications

Normally, adrenaline is employed in the form antiasthmaticum, broncholyticum and sympathicomimeticum. In addition, it is employed to stop or avoid hemorrhages during surgery or when even there is bleeding from an internal organ. Often adrenaline is given along with local anesthetics, as this combination helps to prolong the effects of the anesthetics. Moreover, when you are using adrenaline with local anesthetics it is possible to use the combination in low doses. Usually, adrenaline is associated with stimulation, often sexual arousal. Inside our body, adrenaline acts in a manner that it helps to sustain an stimulated condition, enabling the body to generate an elevated level of energy.

Adrenaline is also used for treating glaucoma, which occurs owing to an obstruction within the eye and it prevents the fluids from flowing out of the eye. This, in turn, increases the pressure inside the eye. Usually, glaucoma results in pain as well as uneasiness in the eye. In such cases, administration of adrenaline helps to open up the fluid flow from the eye, thereby relieving the pressure within the eye.

In addition, it is advisable that adrenaline be used in the form of the primary treatment for people who are suffering from anaphylaxis, which is basically the clinical syndrome manifesting majority of the serious systemic allergic reactions. Adrenaline works to invigorate adrenoceptors with a view to augment peripheral vascular resistance and, as a result of this, there is an improvement in the blood pressure as well as coronary perfusion (flow of blood to through the vessels to the coronary arteries). This results in the reversal of peripheral vasodilation as well as a decreased angioedema (swelling in the mucous membranes).

Side effects and cautions

Use of adrenaline is not recommended in patients suffering from hypersensitivity to epinephrine, narrow-angle glaucoma, when one is administered common anesthesia alongside cyclopropane or hydrocarbons, shock owing to non-anaphylactoid reasons, during labor (it may lead to delaying of the second stage) and in the case of coronary insufficiency or cardiac dilation.

It is important to note that using adrenaline is not recommended when there is a cardiac dilation. In addition, adrenaline should not be administered to majority of the patient enduring arrhythmias (disturbed heartbeat rhythm) and cerebral arteriosclerosis (thickening of the arteries supplying blood to the brain), in instances where use of vasopressor drugs are prohibited, for instance, in the case of thyrotoxicosis (hyperthyroidism) and in obstetrics provided the blood pressure of the pregnant woman is above 130/ 80 mm/ Hg. Use of adrenaline is also prohibited in shock (except for anaphylactic shock - a severe allergic condition wherein a patient is so sensitive that he may lose consciousness), while one is being administered general anesthesia together with cyclopropane or halogenated hydrocarbons and in patients suffering from organic brain injury. Besides the above warnings, adrenaline should never be administered in injection form into the ears, fingers, toes or genitalia.

Use of adrenaline has the potential to bring about vomiting, arrhythmias (particularly when the patient is already suffering from an organic heart ailment or has been administered a different drug that makes the heart sensitive to arrhythmias), hypertension or high blood pressure (particularly when given in excessive dosage), lactic acidosis (owing to excessive dosage or using it for an extended period of time) and hyperuricemia (excessive uric acid in the blood). Besides, adrenaline may also result in a feeling of fright or nervousness, and excitability. In addition, repeated administering adrenaline as an injection may lead to necrosis (death of a portion of tissue) at the site where the injection is administered.

Additional caution ought to be exercises when adrenaline is being used on patients having prefibrillatory rhythm, ventricular fibrillation (a fatal form of arrhythmia), circulatory collapse caused by phenothiazine, myocardial infarction, tachycardia (exceptionally fast heartbeat), and prostatic hypertrophy. It is advisable that in addition to exercising caution, adrenaline should be administered slowly in aged patients as well as people having diabetes mellitus, hypertension, psychoneurosis and hyperthyroidism. Adrenaline should also be administered very carefully in patients who are suffering from bronchial asthma for a prolonged period as well as those with emphysema and also enduring a degenerative heart disease. Provided one is suffering from coronary insufficiency, administration of adrenaline may result in angina pain. It is also advisable that you should use adrenaline with great caution in patients suffering from narrow angle glaucoma.

It is not advisable to administer adrenaline in conjunction with any other sympathomimetic agents, as it may result in additive effects as well as enhanced toxicity. Halothane as well as different other anesthetics, for instance, trichloroethylene and cyclopropane, augment the chances of developing arrhythmias and severe pulmonary edema caused by adrenaline provided the patient is already suffering from hypoxia (insufficient amount of oxygen in the blood). Physically, adrenaline does not match with metals, alkalis, oxidising agents, hyaluronidase, sodium warfarin and several other medications. When used in combination with sodium bicarbonate, adrenaline materializes into polymers.

Some of the common side effects of using adrenaline include an elevated blood pressure, enhanced heartbeat, a thumping heart, a temporary headache, nervousness and trembling. It may also result in disorientation, an agitated psychomotor, psychosis or mental illness as well as impaired memory. The possible serious undesirable effects of using adrenaline actually occur from its impact on the blood pressure as well as the heart rhythm. In some cases patients may also experience ventricular fibrillation and serious hypertension (high blood pressure), it may even result in cerebral hemorrhage plus pulmonary edema. Administering an excessive dosage of adrenaline may even lead to serious metabolic acidosis owing to the high intensity of lactic acid in the bloodstream. Other symptoms related to excessive dosage of adrenaline or unintended IV administration of IM or SQ doses may include headache, chest pain, and vomiting, quick augmentation of systolic, diastolic as well as venous blood pressure, pulmonary edema plus dyspnea, and cardiac arrhythmias. In addition, adrenaline overdose may also cause cerebral haemorrhages owing to a sudden rise in the blood pressure. Other adverse effects of using adrenaline may also include metabolic acidosis, renal failure and cold skin.

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