adrenal crisis

adrenal crisis

n.

See acute adrenocortical insufficiency.

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adrenal crisis,

an acute, life-threatening state of profound adrenocortical insufficiency in which immediate therapy is required. It is characterized by glucocorticoid deficiency, a drop in extracellular fluid volume, and hyperkalemia. Also called crisis. See also Addison's disease, adrenal cortex.

observations Typically, the patient appears to be in shock or coma with a low blood pressure, weakness, and loss of vasomotor tone. The person's medical history may include abrupt discontinuation of exogenous steroids or Addison's disease or reveal symptoms indicating its presence. Results of laboratory tests show hyperkalemia and hyponatremia.

interventions An IV isotonic solution of sodium chloride containing a water-soluble glucocorticoid is administered rapidly. Vasopressor agents may be necessary to combat hypotension. If the patient is vomiting, a nasogastric tube is inserted to prevent aspiration and relieve hyperemesis. Total bed rest and monitoring of blood pressure, temperature, and other vital signs are mandatory. After the first critical hours, the patient is followed as for Addison's disease, and corticosteroid dosage is tapered to maintenance levels. Infection and a failure to increase the maintenance glucocorticoid (steroid) dose are common causes of crisis in people who have Addison's disease.

nursing considerations Nursing care during adrenal crisis includes eliminating all forms of stimuli, especially loud noises or bright lights. The patient is not moved unless absolutely necessary and is not allowed to perform self-care activities. If the condition is identified and treated promptly, the prognosis is good. Discharge instructions include a reminder to the patient to seek medical attention in any stressful situation, whether physiologic or psychologic, to prevent a recurrence of the crisis.

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adrenal crisis,

n See crisis, adrenal.

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crisis

pl. crises [L.]

1. the turning point of a disease for better or worse; especially a sudden change, usually for the better, in the course of an acute disease.

2. a sudden paroxysmal intensification of signs in the course of a disease.

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addisonian crisis

signs of severe depression, muscle weakness, vomiting and diarrhea accompanying an acute attack of adrenocortical insufficiency (Addison's disease). Called also adrenal crisis.

adrenal crisis

see addisonian crisis (above).

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adrenal crisis

Addisonian crisis, acute adrenal insufficiency Endocrinology Acute life-threatening adrenocortical insufficiency with ↓ serum cortisol, seen in Pts with Addison's disease Triggers Infections, trauma, hemorrhage, TB, surgery, dehydration with salt deprivation, destruction of pituitary gland or evoked by replacing thyroid hormone in Pts with hypothyroidism of hypothalamic or pituitary origin and underlying mild ACTH deficiency Clinical Hypotension, shock, fever, dehydration, anorexia, weakness, apathy, headache, vomiting, chills, tachycardia, sweating Lab ↓ Na+, ↑ K+, ↑ WBCs, eosinophilia, hypoglycemia Management Pharmacologic doses of IV hydrocortisone, BP support