addisonian crisis

Question 1

addisons

Answer 1

disease of adrenal cortex, cause hyposecretion of all 3 (sex, salt, sugar)
most severe effects from decreased cortisol (gluconeogenesis to increased BS)

Question 2

etiology

Answer 2

idiopathic, autoimmune, other

Question 3

patho

Answer 3

adrenal gland destroyed, s/s when 90% nonF -> advanced before dx
ACTH and MSH secreted in large amounts

Question 4

cm

Answer 4

hypoT: decreased vascular tone, decreased CO, decreased circulating blood V
Na craving: decreased Na, increased K, dehyd
hypogly, weak and fatigue
unsuppressed ACTH: hyperpig

Question 5

pharm

Answer 5

lifelong steroid (gluco and maybe mineral)
issues: timing important, doses small, never abruptly stop, increase w/ stress: 3x3; med alert bracelet, always have emergency supply (inject and oral)

Question 6

complication

Answer 6

addisonian crisis
cause = sudden insuff or corticosteroids
from adrenal gland, increased stress, no meds
most common with primary

Question 7

addisonian crisis: cm

Answer 7

sudden penetrating pain in lower back, abd, legs: hypoNa
severe v/d, dehyd, hypoT, hyperK (ecg changes), and hypoNa
CNS: loss of consciousness, confusion, slurred speech
death if untreated

Question 8

addisonian crisis: tm

Answer 8

IV: hydrocortisone (bolus, then q6), saline (Na), dextrose (for E), saline and dextrose based on V status and UO
switch to PO when able: taper dose until maintenance dose achieved