Acute adrenal crisis

Question 1

What is acute adrenal crisis:

Answer 1

A life threatening state of adrenocorticosteroid hormone deficiency leading to hypotension and hemodynamic shock

Question 2

What are clinical features of AAC?

Answer 2

Hypotension/shock, orthostatic hypotension. 
Anorexia, nausea/vomiting
Abdominal pain 
Fever 
Lethargy/weakness

Question 3

What is your DDx for someone who presents with clinical features of acute adrenal crisis?

Answer 3

Shock-septic, cardiogenic, spinal
Anaphylaxis
Other causes of hypotension

Question 4

How do you manage AAC?
Of course, the first 2 things:
Then give what fluid?
What labs are you looking for? As soon as you draw labs, what are you doing?
Supporting system with?
Which electrolytes are you trying to correct?

Answer 4

Ensure adequate airway and gas exchange
Administer 100% O2
Expand circulating volume rapidly with dextrose in normal saline (up to 2-3 L may be requried)
draw blood for random cortisol and ACTH levels
As soon as i draw labs, im going to administer IV Glucocorticoid 100 mg IV and q6h as needed
Tyring to correct: hypoglycemia, hyponatremia, hyperkalemia, and hypercalcemia

Question 5

Precipitating cause?

Answer 5

iatrogenic adrenal insufficiency due to exogenous corticosteroid administration

Question 6

Side note: What is Addison’s disease?

Answer 6

also called adrenal insufficiency, is an uncommon disorder that occurs when your body doesn’t produce enough of certain hormones