Adrenal Crisis**** Flashcards
Why does it happen?
A sudden drop in glucocorticoids
Presentation:
They present shocked. What signs and symptoms you might see?
What 2 signs should you be looking out for?
Postural hypotension Feeble rapid pulse Weakness Confusion Fever GI - severe abdo pain (can present as acute abdomen), anorexia, N&V
ABDO PAIN and LOW BP
Causes and triggers:
What may someone with known Addison’s do to trigger this?
How may surgery lead to this?
Why is infection (e.g. pneumonia) a trigger?
Waterhouse-Friderichsen’s syndrome is caused by meningococcal sepsis. What happens leading to an adrenal crisis?
What other physiological stress may the patient go through to trigger this?
Miss steroid meds or stop them abruptly
Low steroid dose due to surgery NBM
Increased need during infection
Bilateral adrenal haemorrhage due to meningococcal sepsis
Infection Trauma Surgery Pregnancy General anaesthetic
Investigations:
What type of acid-base imbalance will they have?
Glucose?
U&E - what do you expect with dehydration?
Non-anion gap metabolic acidosis
Hypoglycaemia - due to low cortisol
Low Na and high K
Management:
Rx before results if suspected!!!!!!
What blood test is done?
What is given IV STAT
What needs to be monitored as it is likely to drop which can be dangerous?
DON’T FORGET TO REHYDRATE THEM!
Cortisol and ACTH - taken straight to the lab - call ahead
U&E - may have hyperkalaemia - check ECG and give calcium gluconate if needed
Hydrocortisone 100 mg ***
Glucose - hypoglycaemia is a risk
Fluid + Steroid
Management:
5S’s of management
Supportive Rx Saline Sugar Steroids Search for cause
