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💀 Adrenal Crisis - #MEDSHED
🌊 Pathogenesis
Adrenal crisis is a life-threatening medical emergency secondary to adrenal insufficiency (lack of gluco- or mineralcorticoid secretion from adrenal cortex)
Primary: failure of adrenal gland
Autoimmune, infection, genetic, etc.
Secondary: impaired stimulation via ACTH or CRH
Tumor, iatrogenic, vascular, etc.
Adrenal crisis should be treated with strong clinical suspicion rather than waiting for confirmatory labs
👀 Treatment
Address underlying/precipitating etiology
Corticosteroid non-compliance, infections, infarcts, drug-induced, etc.
Fluid resuscitation
Reverse volume depletion and Na deficiency
NS (Na 154 mEq/L) or LR (Na 130 mEq/L)
Risk of osmotic demyelination syndrome (ODS) with overcorrection of severely low Na
Corticosteroid replacement
Hydrocortisone 100 mg IV/IM, then 50 mg IV/IM every 6 hours until patient can tolerate orals
Avoid dexamethasone since it doesn’t have mineralcorticoid properties
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Not medical advice. Educational purposes only. No relationships to report.
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