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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crisis [kri´sis] (pl. cri´ses) (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 symptoms in the course of a disease.

3. life crisis.

addisonian crisis (adrenal crisis) the symptoms accompanying an acute onset or worsening of addison's disease: anorexia, vomiting, abdominal pain, apathy, confusion, extreme weakness, and hypotension; if untreated these progress to shock and then death.

aplastic crisis a sickle cell crisis in which there is temporary bone marrow aplasia.

blast crisis a sudden, severe change in the course of chronic granulocytic leukemia, characterized by an increased number of blasts, i.e., myeloblasts or lymphoblasts.

catathymic crisis an isolated, nonrepetitive act of violence that develops as a result of intolerable tension.

celiac crisis an attack of severe watery diarrhea and vomiting producing dehydration and acidosis, sometimes occurring in infants with celiac disease.

developmental crisis maturational crisis.

hemolytic crisis an uncommon sickle cell crisis in which there is acute red blood cell destruction with jaundice.

hypertensive crisis dangerously high blood pressure of acute onset.

identity crisis a period in the psychosocial development of an individual, usually occurring during adolescence, manifested by a loss of the sense of the sameness and historical continuity of one's self, confusion over values, or an inability to accept the role the individual perceives as being expected by society.

life crisis a period of disorganization that occurs when a person meets an obstacle to an important life goal, such as the sudden death of a family member, a difficult family conflict, an incident of domestic violence (spouse or child abuse), a serious accident, loss of a limb, loss of a job, or rape or attempted rape.

maturational crisis a life crisis in which usual coping mechanisms are inadequate in dealing with a stress common to a particular stage in the life cycle or with stress caused by a transition from one stage to another. Called also developmental crisis.

myasthenic crisis the sudden development of dyspnea requiring respiratory support in myasthenia gravis; the crisis is usually transient, lasting several days, and accompanied by fever.

oculogyric crisis a symptom of an acute dystonic reaction in which the person demonstrates a fixed gaze, usually upward; also, the uncontrollable rolling upwards of the eye. It can be a result of encephalitis or a reaction to antipsychotic medications.

salt-losing crisis see salt-losing crisis.

sickle cell crisis see sickle cell crisis.

tabetic crisis a painful paroxysm occurring in tabes dorsalis.

thyroid crisis (thyrotoxic crisis) see thyroid crisis.

vaso-occlusive crisis a sickle cell crisis in which there is severe pain due to infarctions in the bones, joints, lungs, liver, spleen, kidney, eye, or central nervous system.

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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