Emergency Care: Emergency Care: Addisonian Crisis & Addisonian Crisis & Adrenal InsufficiencyAdrenal Insufficiency

Addisonian CrisisAddisonian Crisis

Addisonian Crisis is an acute exacerbation Addisonian Crisis is an acute exacerbation of symptoms in someone with Addison’s of symptoms in someone with Addison’s disease (namely adrenal insufficiency)disease (namely adrenal insufficiency)

Whereas Cushing’s syndrome is seen in Whereas Cushing’s syndrome is seen in patients with patients with excessexcess corticosteroids, corticosteroids, Addison’s disease is seen in someone Addison’s disease is seen in someone with a with a deficiencydeficiency in corticosteroids. in corticosteroids.

Addison’s DiseaseAddison’s Disease

Much like Thyroid disease, Addison’s Much like Thyroid disease, Addison’s disease is failure of some aspect the disease is failure of some aspect the complex system of hormones and complex system of hormones and feedback loopsfeedback loopsAlso, like Thyroid disease, there may be Also, like Thyroid disease, there may be dysfunction as these hormones and dysfunction as these hormones and messengers interact with the messengers interact with the hypothalamus, pituitary and the site of hypothalamus, pituitary and the site of hormone release (in this case the adrenal hormone release (in this case the adrenal glands)glands)

Adrenal Function SummaryAdrenal Function SummaryThe Adrenal Gland releases… Androgens (sex

hormones)

Mineralocorticoids

Glucocorticoids

Glucocortoicoids(most potent is cortisol)

Action: anti-inflammatory, growth suppressing,

affects sleep patterns & awareness, stress response

Mineralcorticoids(Aldosterone)

Action: Managessodium/potassium balance

Connecting the dots…Connecting the dots…

Addison’s Addison’s DiseaseDisease

Addison’s disease can be a lack of all three Addison’s disease can be a lack of all three hormones or just glucocorticoids and hormones or just glucocorticoids and androgrenandrogren

Caused by:Caused by:Destruction of the adrenal glands by Destruction of the adrenal glands by infectioninfectionAutoimmune attackAutoimmune attackMutation in the ACTH receptor on adrenal Mutation in the ACTH receptor on adrenal cellscells

Addisonian Addisonian CrisisCrisis

Triggered by anything that increases the Triggered by anything that increases the person’s normal stress level: surgery, infection, person’s normal stress level: surgery, infection, emotional trauma, physical trauma as well as emotional trauma, physical trauma as well as sudden withdrawal from sterioids or post-sudden withdrawal from sterioids or post-adrenalectomy adrenalectomy

The body is unable to release sufficient cortisol The body is unable to release sufficient cortisol to respond appropriatelyto respond appropriately

Result is: Hypotension, tachycardia, Result is: Hypotension, tachycardia, dehydration, hypoglycemia, hyponatremia, dehydration, hypoglycemia, hyponatremia, hyperkalemia, fever, weakness & confusionhyperkalemia, fever, weakness & confusion

May lead to shock & vascular collapseMay lead to shock & vascular collapse

WorksheetWorksheet

Review the provided education sheet from Review the provided education sheet from the Addison’s Disease Self-Help Groupthe Addison’s Disease Self-Help Group

http://www.adshg.org.uk/info/manual/crisishttp://www.adshg.org.uk/info/manual/crisismanagement.pdfmanagement.pdf

Review the last three slides Review the last three slides

Fill in your worksheetFill in your worksheet

Addisonian Crisis: Addisonian Crisis: Education/Nursing CareEducation/Nursing Care

Prevention through careful titration of Prevention through careful titration of steroidssteroids

““Steroid coverage” for stressful events (i.e. Steroid coverage” for stressful events (i.e. preoperatively, hot weather, flu, etc.)preoperatively, hot weather, flu, etc.)

Patient, family, friends aware of Patient, family, friends aware of signs/symptoms of crisissigns/symptoms of crisis

Wallet card/med alert bracelet explaining Wallet card/med alert bracelet explaining condition, medications, and how to condition, medications, and how to respond in an emergencyrespond in an emergency

Addisonian Crisis: Addisonian Crisis: Education/Nursing CareEducation/Nursing Care

Treatment focuses on getting patient the Treatment focuses on getting patient the cortisol they need to have their body cortisol they need to have their body respond appropriately (PO, IV, IM routes)respond appropriately (PO, IV, IM routes)

Patient should always carry emergency Patient should always carry emergency dose, usually 100mg IM hydrocortisonedose, usually 100mg IM hydrocortisone

Return demonstration with normal saline Return demonstration with normal saline before dischargebefore discharge

Highly Recommended !!!Highly Recommended !!!

Review Corticosteroid Therapy on pp. Review Corticosteroid Therapy on pp. 1332-13341332-1334

Probably don’t remember the information Probably don’t remember the information from when you were in Pharmfrom when you were in Pharm

Will help you on test and on NCLEXWill help you on test and on NCLEX

Key information in caring for patients who Key information in caring for patients who are taking corticosteroidsare taking corticosteroids