ABC: časopis urgentne medicine (Jan 2016)
Rare conditions in emergency medicine that immediately threatens patient's life: Adrenal (Addisonian) crisis
Abstract
Aim: To point out to significance of emergency physician in prehospital treatment of conditions which we rarely meet in our everyday practice and which immediately threaten patient's life. Matherial and methods: retrospective analysis of medical documentation of the department for emergency medical service and the internal medicine ward of General Hospital Loznica. Results (case report): Emergency medical team comes on the field in a village 35 km from the base and meets 47 year old female patient, adynamic, confuse, in a complete exhaustion. She complains of severe pains in muscles, pain in the area of abdomen and lumbosacral spine. The patient states that she has vomited several times during the day. She receives treatment for hypertension. She states that she received treatment for tuberculosis 20 years ago. Vital parameters: body temperature: 38,6 °C,TA:80/50 mmHg, glycemia: 3,2 mmol/L, ECG: sinus tachycardia, Fr 120. In a bag with medicines we find empty packets of tablets Hydrocortisone of 20 mg. we find out that she has not used this medicine for 7 days. We diagnose primary adrenalin insufficiency caused by tuberculosis process and start treatment. On establishing venous line, we immediately give 100 mg of hydrocortisone slowly in bolus and after that 500 ml 0, 9% solution of NaCl with 20 ml 50 % glucoses with the aim of normalizing glycemia and hypovolemia. During the transport we continue with infusion therapy with solution of 5 % glucoses. On admission on internal medicine ward, her mental status was improved, TA: 100/60 mmHg. Conclusion: Acute insufficiency of adrenal cortex, Addisonian or adrenal crisis is an urgent state because of sudden and large reduction or complete cession of secretion of hormones of adrenal cortex which immediately threatens patient's life. If there is any suspicion of adrenal insufficiency it is necessary to start treatment without delay and waiting on diagnosis procedures. Timely application of glucocorticoids and normalization of hypovolemia by isotonic solutions of NaCl and glucoses saves life of these patients.
