Vagal hypotension after percutaneous biopsy: possible confusion with hypovolemic shock

Vagal hypotension can occur after percutaneous biopsy and be misdiagnosed as hypovolemia due to hemorrhage. Inappropriate exploratory surgery and death have resulted. Increased vagal tone or massive discharge is characterized by hypotension with bradycardia or lack of tachycardia and can occur after many stimuli including contrast medium injection, anxiety, and needle insertion. Vagal reactions can be mild and self-limited, but can also progress to cardiac arrest. Atropine 0.6 to 0.8 mg intramuscularly or intravenously in increments up to 3 mg has been recommended for prompt treatment. Volume expansion is adjunctive.