Difference between revisions of "Adrenal Crisis-Congenital Adrenal Hyperplasia (CAH)"

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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.  
*'''''If you get a call on a pediatric patient with CAH who is in crisis, find out if the caretakers have a dose of IM Solucortef for emergencies and give this ASAP'''''.  
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*Make arrangements for medevac.
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==Adult Adrenal Crisis==
*If the patient has no emergency solucortef available, you can give dexamethasone from the village formulary
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Shock, with hypotension, hypovolemia and possible nonspecific symptoms such as anorexia, nausea, vomiting, abdominal pain, weakness, fatigue, lethargy, fever, confusion, or coma
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*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.
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*Give dexamethasone 4 mg IM.
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*Continue NS IV fluid hydration
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*Frequent hemodynamic monitoring and measurement glucose to avoid fluid overload and hypoglycemia
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 +
 
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==Pediatric Adrenal Crisis with Hypopit/Congenital Adrenal Hyperplasia==
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[[file:instaglucose-sb.png|right|350px]]
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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 14:56, 10 September 2019

All Emergency RMT.png

Pediatric Critical Care Guide


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

Instaglucose-sb.png

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

General Information about CAH