Recognizing and Managing Adrenal Disorders in the Emergency Department
×
EMPOWERING PHYSICIANS WITH EVIDENCE-BASED CONTENT
 

Home > EB Store > Recognizing and Managing Adrenal Disorders in the Emergency Department

Recognizing and Managing Adrenal Disorders in the Emergency Department
Enlarge Image
Delivery Method:

Recognizing and Managing Adrenal Disorders in the Emergency Department - $39.00

Publication Date: September 2017 (Volume 19, Number 9)

CME: This issue includes 4 AMA PRA Category 1 Credits™; 4 ACEP Category I credits; 4 AAFP Prescribed credits; and 4 AOA Category 2 A or 2B CME credits

Authors
 
Amy Cutright, MD
Assistant Professor of Emergency Medicine, Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE
 
Stephen Ducey, MD
Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE
 
Claudia L. Barthold, MD
Assistant Professor of Emergency Medicine, Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE
 
Peer Reviewers
 
William A. Knight, IV, MD, FACEP
Associate Professor, Emergency Medicine and Neurosurgery, Medical Director, Emergency Medicine Advanced Practice Provider Program, Associate Medical Director, Neuroscience ICU, University of Cincinnati Medical School, Cincinnati, OH
 
Christopher Zammit, MD
Assistant Professor of Emergency Medicine, Neurology, Neurosurgery, and Internal Medicine, University of Rochester Medical Center, Rochester, NY
 
 
Abstract
 
Primary and secondary adrenal insufficiency are underrecognized conditions among emergency department patients, affecting an estimated 10% to 20% of critically ill patients. The signs and symptoms of cortisol deficit can be nonspecific and wide-ranging, and identification and swift treatment with stress-dosing of hydrocortisone is vital to avoid life-threatening adrenal crisis. Laboratory evaluation focuses on identification of electrolyte abnormalities typical of adrenal insufficiency, and while additional testing may depend on the type and severity of symptoms, it should not delay corticosteroid replacement. This issue provides recommendations on effective management of patients presenting with adrenal insufficiency, with particular attention to the management of critically ill and septic patients, pregnant patients, and children.
 
Excerpt From This Issue
 
A 56-year-old man presents complaining of a productive cough, fatigue, and shortness of breath. A chest x-ray demonstrates a left lower lobe infiltrate, and he is diagnosed with community-acquired pneumonia. His blood pressure, which was 119/67 mm Hg upon arrival, has decreased to 83/52 mm Hg on reassessment after the chest x-ray. You order antibiotics, and he is given a 30 mL/kg bolus of IV fluids. His blood pressure remains low, at 82/40 mm Hg. You arrange admission to the ICU, and initiate a norepinephrine infusion titrated to a mean arterial pressure of 65 mm Hg, as well as an additional IV fluid bolus. Despite the 30 mcg/min norepinephrine infusion, the patient’s MAP is still < 60 mm Hg. You perform a focused bedside ultrasound and note that his inferior vena cava measures 2.2 cm, with minimal respiratory variation. You wonder if you should just add on an additional vasopressor, or if there is something else you should consider…

A 24-year-old woman presents with complaint of nausea with vomiting and diarrhea for 3 days. She has not been able to keep anything down, including any of her medications, for the last 36 hours. A review of her chart reveals that she has primary adrenal insufficiency. Her triage vital signs include mild hypotension of 81/48 mm Hg and tachycardia, at 120 beats/min. Two liters of IV normal saline (0.9% sodium chloride) are ordered, and antiemetics are administered. Her tachycardia begins to improve, but her blood pressure remains low, with systolic blood pressure in the low 80s. You wonder: What is the best way to replace steroids, and is there any indication for obtaining cortisol levels or ACTH stimulation testing?

 

100% Money-Back Gurantee

 
About EB Medicine:
Products:
Accredited By:
ACCME ACCME
AMA AMA
ACEP ACEP
AAFP AAFP
AOA AOA
AAP AAP
Endorsed By:
AEMAA AEMAA
HONcode HONcode
STM STM

 

Last Modified: 12/17/2018
© EB Medicine