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

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==Pediatric Adrenal Crisis with Hypopit/Congenital Adrenal Hyperplasia==
 
==Pediatric Adrenal Crisis with Hypopit/Congenital Adrenal Hyperplasia==
 
[[file:instaglucose-sb.png|right|350px]]
 
[[file:instaglucose-sb.png|right|350px]]
 +
[[file:Dexamethasone_Stress_Dose.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
 
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.
 
*Establish intravenous access.
*Get accucheck glucose. If glucose result is unknown (ie machine not working), low or undetectable give instaglucose per table
+
*Get accucheck glucose. If glucose result is unknown (ie machine not working), low or undetectable give instaglucose per table.  Repeat glucose 15min after giving the glucose gel to confirm that it has normalized
 
*Give 20ml/kg NS bolus quickly as possible.  
 
*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  
 
*Give dexamethasone IM per table, prescribed home emergency solucortef dose IM or give solucortef per table below  
*Frequent hemodynamic, BP and glucose monitoring.
+
*Monitor hemodynamics, BP and glucose q1h until medevac arrives.
 
*Continue 1.5 x maintenance NS IV
 
*Continue 1.5 x maintenance NS IV
 
*Use supportive measures as needed
 
*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]]

Latest revision as of 17:41, 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
Dexamethasone Stress Dose.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. Repeat glucose 15min after giving the glucose gel to confirm that it has normalized
  • 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
  • Monitor hemodynamics, BP and glucose q1h until medevac arrives.
  • Continue 1.5 x maintenance NS IV
  • Use supportive measures as needed

General Information about CAH