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Adrenal Crisis - #MEDSHED

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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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