I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.
You can find more things on the FRCEM on this site here.
Causes of an addisonian crisis?
- Withdrawal of steroid therapy (>5mg pred/day for 4 weeks considered a threshold)
- Addison’s Disease (the idiopathic autoimmune one)
- associated with
- Grave’s
- Hashimoto’s
- IDDM
- Pernicious anaemia
- Hypoparathyroidism
- Ovarain Failure
- Other zebras include
- adrenal haemorrhage
- metastatic disease
- TB
[collapse]
Clinical Features and lab findings?
- shock and esp postural hypotension and syncope
- abdo pain
- vomiting
- muscle weakness
- confusion and reduced LOC
- low BSL
Lab findings
- Famously low sodium and high potassium
- Low sugar
- a metabolic acidosis can be common along with AKI
[collapse]
What is the recommended management in the UK?
- i had something in my head here about giving dex to avoid screwing up the tests but this is not mentioned anywhere I can find including the UK society for endocrinology.
- OHEM states
- take blood for cortisol and ACTH
- give saline
- give hydrocortisone 100mg
[collapse]
