The Internet Book of Critical Care Podcast IBCC Episode 15 Adrenal Crisis
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Dec 12, 2018 This podcast covers the identification, workup, and treatment of adrenal insufficiency, including the importance of diagnosing and treating adrenal crisis in critical care. It explores laboratory findings and testing methods, emphasizes the impact of steroid use on ACTH DIM tests, and discusses the treatment and resuscitation approaches for adrenal crisis. A comprehensive guide for managing patients with adrenal insufficiency.
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Identify At-Risk Patients
- Look for adrenal crisis mainly in patients on chronic steroids or with Addison's disease after a stressor.
- Consider infections, trauma, surgery, dehydration, psychological stress, missed steroid doses, and certain drug interactions as triggers.
Blood Cell Counts Reveal Insufficiency
- Normally, physiologic stress raises cortisol and lowers eosinophil count; high eosinophils suggest adrenal insufficiency.
- Neutrophil to lymphocyte ratio may also indicate adrenal status if it stays normal during stress.
Testing Guidelines for Adrenal Crisis
- For suspected adrenal insufficiency, check a random cortisol level first; >20 excludes it.
- Use dexamethasone if testing with ACTH stimulation to avoid interference from other steroids.