Addisonian Crisis

Question 1

Pathophysiology (PITS)

Answer 1

State of acute insufficiency of adrenocortical hormones = SEVERE adrenal insufficiency
- poor medical compliance
- infection
- trauma
- surgery
- MI
Corticosteroids are involved in renal excretion of K+ acid as well as Na+ reabsorption
Hence adrenal insufficiency results in a metabolic acidosis coupled with hyperkalemia there is also haemodynamic instability due to Na+ -> fluid loss

Question 2

Aetiology

Answer 2

• Steroid withdrawal: Any patient on long term steroids should no abruptly withdraw their medication
• Severe dehydration
• Sepsis or surgery: resulting in active exacerbation of pre-existing adrenal insufficiency (Addison’s disease)
• Meningococcal infection: can lead to adrenal hemorrhage (Waterhouse-Friderichsen syndrome)

Question 3

Diagnosis

Answer 3

12 lead-ECG - hyperkalemic changes
- Absent P waves (GO)
- Prolonged PR interval (GO LONG)
- Tall, tented T waves (GO TALL)
- Wide QRS complex (GO WIDE)

VBG - metabolic acidosis
- hyponatremia
- hyperkalemia
- hypoglycemic
U + E’s
- hyponatremia
- hyperkalemia
- AKI
FBC + CRP
- leukocytes
- raised CRP

Question 4

Treatment

Answer 4

IMMEADIATE HYDROCORTISONE
+ Iv saline
+ dextrose if hypoglycemic