Tasty Morsels of EM 075 – #FRCEM Addisonian Crisis

24 Jul

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

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

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


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