Emergency Care: Addisonian Crisis

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Emergency Care Addisonian Crisis Adrenal
Insufficiency
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Addisonian Crisis

• Addisonian Crisis is an acute exacerbation of
  symptoms in someone with Addisons disease
  (namely adrenal insufficiency)
• Whereas Cushings syndrome is seen in patients
  with excess corticosteroids, Addisons disease is
  seen in someone with a deficiency in
  corticosteroids.

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Addisons Disease

• Much like Thyroid disease, Addisons 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)

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Adrenal Function Summary
The 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
Manages sodium/potassium balance
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Connecting the dots
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Addisons Disease

• Addisons 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

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Addisonian Crisis

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

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Worksheet

• Review the provided education sheet from the
  Addisons Disease Self-Help Group
• http//www.adshg.org.uk/info/manual/crisismanageme
  nt.pdf
• Review the last three slides
• Fill in your worksheet

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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

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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

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Highly Recommended !!!

• Review Corticosteroid Therapy on pp. 1332-1334
• Probably dont 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