Diferencia entre revisiones de «Adrenal crisis»
(Created page with "==Diagnosis== - fever, hypoTN (refractory to fluids), hyperpigmentation by increased ACTH - cushingoid look by chronic steroid use - think about in kids with congenital adren...") |
Sin resumen de edición |
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* Major factor precipitating adrenal crisis is mineralocorticoid, not glucocorticoid, deficiency | |||
* Major clinical problem is hypotension | |||
* Most commonly presents as shock | |||
==Clinical Manifestations== | |||
* Hypotension | |||
* Refractory to fluids | |||
* Volume depletion | |||
* Abdominal tenderness | |||
* Usually generalized | |||
* Fever | |||
* Usually caused by infection (source must be identified and treated) | |||
Lab tests | |||
* Hyperkalemia | |||
* Hyponatremia | |||
* | |||
fever, hypoTN (refractory to fluids), hyperpigmentation by increased ACTH | |||
- | - cushingoid look by chronic steroid use | ||
- | - think about in kids with congenital adrenal hyperplasia (CAH) who present with shock | ||
== | ==Workup== | ||
* Chemistry/glucose | |||
* Guides therapy | |||
* Cortisol level | |||
* Confirms diagnosis | |||
* Renin, ACTH | |||
* For evaluating differential diagnosis if cortisol level normal | |||
Treatment== | |||
Treat underlying cause | * Do not wait for lab results to start treatment | ||
* Fluids | |||
* Infuse 2-3L of NS or D5NS (to correct hypoglycemia) | |||
* Avoid hypotonic fluids (may worsen hyponatremia) | |||
* Glucocorticoids | |||
* Patient without previous diagnosis of adrenal insufficiency | |||
* Dexamethasone 4mg IV bolus is preferred tx | |||
* Patient with known primary adrenal insufficiency w/ potassium > 6 | |||
* Hydrocortisone 100mg IV bolus (preferred due to its mineralcorticoid activity) | |||
* Mineralocorticoids are not indicated in acute management | |||
* Treat underlying cause | |||
== == | |||
==Source == | ==Source == | ||
7/2/09 PANI (Adapted from Mistry) | 7/2/09 PANI (Adapted from Mistry), UpToDate | ||
Revisión del 23:38 1 mar 2011
Diagnosis
- Major factor precipitating adrenal crisis is mineralocorticoid, not glucocorticoid, deficiency
- Major clinical problem is hypotension
- Most commonly presents as shock
Clinical Manifestations
- Hypotension
- Refractory to fluids
- Volume depletion
- Abdominal tenderness
- Usually generalized
- Fever
- Usually caused by infection (source must be identified and treated)
Lab tests
- Hyperkalemia
- Hyponatremia
fever, hypoTN (refractory to fluids), hyperpigmentation by increased ACTH
- cushingoid look by chronic steroid use
- think about in kids with congenital adrenal hyperplasia (CAH) who present with shock
Workup
- Chemistry/glucose
- Guides therapy
- Cortisol level
- Confirms diagnosis
- Renin, ACTH
- For evaluating differential diagnosis if cortisol level normal
Treatment==
- Do not wait for lab results to start treatment
- Fluids
- Infuse 2-3L of NS or D5NS (to correct hypoglycemia)
- Avoid hypotonic fluids (may worsen hyponatremia)
- Glucocorticoids
- Patient without previous diagnosis of adrenal insufficiency
- Dexamethasone 4mg IV bolus is preferred tx
- Patient with known primary adrenal insufficiency w/ potassium > 6
- Hydrocortisone 100mg IV bolus (preferred due to its mineralcorticoid activity)
- Mineralocorticoids are not indicated in acute management
- Treat underlying cause
Source
7/2/09 PANI (Adapted from Mistry), UpToDate