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Acute Adrenal Crisis
5
Acute Adrenal Crisis
Background
Definition
So... Why do we care?
Dangerously low levels of cortisol
Incidence
42% of people with Adrenal Insufficiency will have at least one episode of acute adrenal crisis. This is more common in Primary Adrenal Insufficiency.
Primary Adrenal Insufficiency has an occurrence of approximately 1:10,000.*
Secondary Adrenal Insufficiency has an occurrence of approximately 1:4,700.*
*Exact numbers are not known
Sources
Mortality
When diagnosed and treated appropriately, there is a 15% mortality rate.
Exact mortality rate is unknown as it is difficult to diagnose.
http://www.eje-online.org/content/162/3/597.full.pdf
http://patient.info/doctor/adrenal-insufficiency-and-addisons-disease
http://patient.info/doctor/adrenal-crisis
http://www.ncbi.nlm.nih.gov/pubmed/19955259
http://emedicine.medscape.com/article/116716-overview#a6
http://endocrinesurgery.ucla.edu/patient_education_adm_acute_adrenal_crisis.html
https://en.wikipedia.org/wiki/Addison%27s_disease
http://caresfoundation.org/wp-content/uploads/2014/08/TN_EMS_Adrenal_Insufficiency_Protocol_Guideline-June-2011.pdf
Causes
Physiology
How'd We Get Here?
Normal Function
Symptoms
Risk Factors
Prehospital Treatment
Patient Management:
Hypotension: NS, Epi Drip, or Dopamine
Hypoglycemia: D50/10
Hyperkalemia: Calcium Chloride
N/V: Zofran, Solu-Medrol (w/PMHx indicating AAC)
Future Management Option:
Solu-Cortef
Adult: 100mg IM/IO/IV
Pediatric: 2mg/kg IM/IO/IV