RISK FACTORS

  • Congenital Adrenal hyperplasia
  • Hypopituitarism on replacement therapy
  • Prolonged steroid therapy or sudden withdrawal of treatment
  • Dehydration
  • Infection/ physical stress
  • Injury to the adrenal or pituitary gland
  • Surgery/ Trauma

SYMPTOMS

  • Abdominal pain
  • Altered consciousness
  • Dehydration/ Fatigue
  • Fever/ Headache
  • Low blood pressure
  • Nausea/ vomiting
  • Tachycardia/ Tachypnea

FEATURES

a) Mineralocorticoid deficiency

  • Dehydration
  • Hyperkalaemia
  • Hyponatraemia
  • Pre renal failure

b) Glucocorticoid deficiency

  • Hypoglycaemia ·
  • Weakness
  • Vomiting ·
  • Hypotension

MANAGEMENT

Hourly- 

  • Blood pressure/ Heart rate
  • Respiratory rate.
  • Blood sugars.
  • Neurological observations
  • Input and output chart.

 

Investigations

  • Urea and electrolytes
  • Cortisol levels
  • Blood sugar
  • Cortisol and 17 hydroxyprogesterone
  • ACTH stimulation test

Treatment

In stable patients-

  • Oral fluids
  • Oral fludrocortisone

In persistent vomiting, manage as below-

a) CIRCULATION

In mild dehydration:

Give Maintenance fluids x 1.5 over 24 hrs
In moderate dehydration:

  • 0.9% Saline 10 ml/kg bolus
  • Maintenance plus deficit over 24 hrs.

 

In Shock/Severe dehydration:

  • 0.9% Saline 20 ml/kg bolus.
    Maintenance plus deficit over 24 hrs.

b) IV Hydrocortisone ·

Neonates – 25 mg 1st dose.
10mg QDS · in children <1year
25mg QDS · in children 1-3 years
50mg QDS · in children 4-12 years
75 mg QDS · in children 12+ years

c) Treat Hypoglycaemia as below-

  • Bolus 5 mls/kg 10% glucose

KEY POINTS

  • Give double oral maintenance steroids during periods of stress
  • IM/IV hydrocortisone if vomiting/diarrhoea

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