Adrenal Crisis-Congenital Adrenal Hyperplasia (CAH): Difference between revisions
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Acute adrenal crisis presents as vomiting, diarrhea, dehydration, hypotension and shock. Crisis can be precipitated by illness, trauma and hyperthermia. | Acute adrenal crisis presents as vomiting, diarrhea, dehydration, hypotension and shock. Crisis can be precipitated by illness, trauma and hyperthermia. | ||
* | |||
* | ==Adult Adrenal Crisis== | ||
*If | Shock, with hypotension, hypovolemia and possible nonspecific symptoms such as anorexia, nausea, vomiting, abdominal pain, weakness, fatigue, lethargy, fever, confusion, or coma | ||
*Establish intravenous access with a large-gauge needle. | |||
*Get accucheck glucose and give instaglucose 15-20 gms (1 tube) if needed | |||
*Infuse 2 to 3 liters of saline as quickly as possible. | |||
*Give dexamethasone 4 mg IM. | |||
*Continue NS IV fluid hydration | |||
*Frequent hemodynamic monitoring and measurement glucose to avoid fluid overload and hypoglycemia | |||
==Pediatric Adrenal Crisis with Hypopit/Congenital Adrenal Hyperplasia== | |||
[[file:instaglucose-sb.png|right|350px]] | |||
Shock, with hypotension, hypovolemia and possible nonspecific symptoms such as anorexia, nausea, vomiting, abdominal pain, weakness, fatigue, lethargy, fever, confusion, or coma | |||
*Establish intravenous access. | |||
*Get accucheck glucose. If glucose result is unknown (ie machine not working), low or undetectable give instaglucose per table | |||
*Give 20ml/kg NS bolus quickly as possible. | |||
*Give dexamethasone IM per table, prescribed home emergency solucortef dose IM or give solucortef per table below | |||
*Frequent hemodynamic, BP and glucose monitoring. | |||
*Continue 1.5 x maintenance NS IV | |||
*Use supportive measures as needed | |||
[[Practicing Medicine in Bush Alaska—Some ABCs#Congenital Adrenal Hyperplasia (CAH)|General Information about CAH]] | [[Practicing Medicine in Bush Alaska—Some ABCs#Congenital Adrenal Hyperplasia (CAH)|General Information about CAH]] | ||
Revision as of 22:56, 10 September 2019
Acute adrenal crisis presents as vomiting, diarrhea, dehydration, hypotension and shock. Crisis can be precipitated by illness, trauma and hyperthermia.
Adult Adrenal Crisis
Shock, with hypotension, hypovolemia and possible nonspecific symptoms such as anorexia, nausea, vomiting, abdominal pain, weakness, fatigue, lethargy, fever, confusion, or coma
- Establish intravenous access with a large-gauge needle.
- Get accucheck glucose and give instaglucose 15-20 gms (1 tube) if needed
- Infuse 2 to 3 liters of saline as quickly as possible.
- Give dexamethasone 4 mg IM.
- Continue NS IV fluid hydration
- Frequent hemodynamic monitoring and measurement glucose to avoid fluid overload and hypoglycemia
Pediatric Adrenal Crisis with Hypopit/Congenital Adrenal Hyperplasia
Shock, with hypotension, hypovolemia and possible nonspecific symptoms such as anorexia, nausea, vomiting, abdominal pain, weakness, fatigue, lethargy, fever, confusion, or coma
- Establish intravenous access.
- Get accucheck glucose. If glucose result is unknown (ie machine not working), low or undetectable give instaglucose per table
- Give 20ml/kg NS bolus quickly as possible.
- Give dexamethasone IM per table, prescribed home emergency solucortef dose IM or give solucortef per table below
- Frequent hemodynamic, BP and glucose monitoring.
- Continue 1.5 x maintenance NS IV
- Use supportive measures as needed
