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Emergency Medicine Board Bombs
197. Adrenal Crisis: fire the trebuchets!
Oct 23, 2023
Hosts discuss a patient's presentation in the ED, while introducing their other podcast. They cover adrenal insufficiency, its causes, and diagnosis. They emphasize the importance of recognizing adrenal crisis symptoms and electrolyte abnormalities. Managing adrenal crisis and appropriate dosage of hydrocortisone are also discussed.
19:00
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Quick takeaways
- Adrenal insufficiency can be caused by autoimmune Addison's disease, hypothalamic or pituitary impairment, or abrupt cessation of chronic steroid use.
- Prompt recognition and treatment of adrenal crisis is vital, including stress dose steroids and addressing the underlying cause.
Deep dives
The Case: A 25-Year-Old Male with Vomiting and Fatigue
A 25-year-old male presents to the emergency department with complaints of vomiting and fatigue. Over the past three days, his symptoms have worsened, and he has also noticed increased urine output. He mentions that he has been urinating into a gallon milk jug to minimize flushing. He identifies himself as a "Renney" who travels with the Renaissance fair. He admits to not filling his prescriptions since leaving home, including steroids for his kidney problems. Given his presentation, hyponatremia is expected.
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