Transcript Emergency Care: Thyroid Storm and Addisonian Crisis

Emergency Care:
Addisonian Crisis &
Adrenal Insufficiency
Addisonian Crisis
Addisonian Crisis is an acute exacerbation
of symptoms in someone with Addison’s
disease (namely adrenal insufficiency)
Whereas Cushing’s syndrome is seen in
patients with excess corticosteroids,
Addison’s disease is seen in someone
with a deficiency in corticosteroids.
Addison’s Disease
Much like Thyroid disease, Addison’s
disease is failure of some aspect the
complex system of hormones and
feedback loops
Also, like Thyroid disease, there may be
dysfunction as these hormones and
messengers interact with the
hypothalamus, pituitary and the site of
hormone release (in this case the adrenal
glands)
Adrenal Function Summary
The Adrenal
Gland releases…
Androgens (sex
hormones)
Mineralocorticoids
Glucocorticoids
Glucocortoicoids
Mineralcorticoids
(most potent is cortisol)
(Aldosterone)
Action: anti-inflammatory,
Action: Manages
growth suppressing,
sodium/potassium balance
affects sleep patterns &
awareness, stress response
Connecting the dots…
Addison’s Disease
Addison’s disease can be a lack of all three
hormones or just glucocorticoids and
androgren
Caused by:
Destruction of the adrenal glands by
infection
Autoimmune attack
Mutation in the ACTH receptor on adrenal
cells
Addisonian Crisis
Triggered by anything that increases the
person’s normal stress level: surgery, infection,
emotional trauma, physical trauma as well as
sudden withdrawal from sterioids or postadrenalectomy
The body is unable to release sufficient cortisol
to respond appropriately
Result is: Hypotension, tachycardia,
dehydration, hypoglycemia, hyponatremia,
hyperkalemia, fever, weakness & confusion
May lead to shock & vascular collapse
Worksheet
Review the provided education sheet from
the Addison’s Disease Self-Help Group
http://www.adshg.org.uk/info/manual/crisis
management.pdf
Review the last three slides
Fill in your worksheet
Addisonian Crisis:
Education/Nursing Care
Prevention through careful titration of
steroids
“Steroid coverage” for stressful events (i.e.
preoperatively, hot weather, flu, etc.)
Patient, family, friends aware of
signs/symptoms of crisis
Wallet card/med alert bracelet explaining
condition, medications, and how to
respond in an emergency
Addisonian Crisis:
Education/Nursing Care
Treatment focuses on getting patient the
cortisol they need to have their body
respond appropriately (PO, IV, IM routes)
Patient should always carry emergency
dose, usually 100mg IM hydrocortisone
Return demonstration with normal saline
before discharge
Highly Recommended !!!
Review Corticosteroid Therapy on pp.
1332-1334
Probably don’t remember the information
from when you were in Pharm
Will help you on test and on NCLEX
Key information in caring for patients who
are taking corticosteroids