Addisonian Crisis: Symptoms and Treatment (Nursing)

00:01 Why are we talking about an Addisonian crisis? Well, Nurse Natalie's probably expressing your frustration right there.

00:07 But I want to reinforce the most likely time you're going to see an Addisonian-like crisis is when a patient who has been on higher dose steroids for a fairly long period of time, they've experienced adrenal gland suppression because they've been on those corticosteroids for a long period of time.

00:25 And now, for some reason, either we fail to give them to them, or they decided to stop taking them -- boom! We throw them right into an Addisonian crisis.

00:36 Their adrenal gland starts acting like someone who has Addison's disease because it's been suppressed with the therapy.

00:43 And unless you wean the patient off that medication slowly, you throw them straight into an Addisonian crisis.

00:51 Remember, the Sugar Daddy Syndrome.

00:54 That adrenal gland gets real comfortable, because it's not getting stimulated at all.

00:58 And if you abruptly stop corticosteroid therapy, you'll see the same symptoms that we would see with someone in Addison's disease who's not receiving enough hormone replacement therapy.

01:10 So, let's -- I want to see what you can come up with.

01:14 You already know Cushing's, we've discussed that and you've reviewed that.

01:17 And I've let you know that in Addisonian crisis, the side effects, when you have a real shortage, are going to be the opposite of what you see in Cushing's.

01:25 So before we walk through these, let's have some fun.

01:28 Let's see what you can remember and apply to an Addisonian crisis, the opposite of what you see in Cushing's disease.

01:44 All right.

01:45 Now, we just put a lot of the symptoms up there.

01:48 Because they're dehydrated, you're going to see the fever.

01:51 You're going to see this electrolyte imbalance with that salt, so they're going to be weak and kind of confused because that's how patients act when they have low sodium.

02:00 Your blood pressure is going to be low.

02:03 And we've got the word "postural" there to remind you, that man, when these people stand up, they're really going to get dizzy.

02:10 Why do you have that fast heart rate? Because you have low volume, blood pressure has dropped, and that's a compensatory mechanism by the body.

02:18 You have that low volume because you're dehydrated.

02:21 You don't have enough of that aldosterone available from the adrenal cortex.

02:25 Now, low sodium, higher potassium, which is again, the exact opposite of what we saw in Cushing's.

02:33 Blood sugar also going to be low.

02:35 So look at these guys as a total picture.

02:39 Addisonian crisis.

02:40 It happens in disease, when we don't have good replacement therapy.

02:44 It happens in our patients receiving corticosteroids or people who have Cushing syndrome when, for some reason, they don't receive their medication either.

02:55 Both cases we have adrenal glands that can't function.

02:58 In Addison's disease, it's usually because it's an autoimmune disorder that knocked out the organ.

03:03 In Cushing syndrome, it's because they abruptly stopped taking their medication.

03:09 So how do we fix an Addisonian crisis? Whether it's from Addison's disease, or it's from somebody with Cushing syndrome who stopped taking their medications, I want you to watch for the signs of crisis.

03:20 Now, let's go back and look at that other slide for just a minute.

03:25 What are the biggest problems we have here? Well, let's start on the right side.

03:29 You've got fever.

03:31 Okay, well, I can give you Tylenol for that.

03:33 That's okay.

03:35 I've got low blood pressure because I've gotten dehydrated.

03:39 All right, well, I could give you some IV fluids for that.

03:43 I could probably address that.

03:45 Maybe deal with your sodium, and your blood sugar, I can give you some high carb food if you can swallow.

03:50 Yeah, none of that is going to work until you do this next thing.

03:56 You have to replace the hormones.

03:59 You are just trying to fix a problem that you will never fix until you replace those hormones.

04:06 You need to, most importantly, replace those hormones and do all that other stuff.

04:11 It'll fall into place if we can replace the hormones and provide rehydration and deal with their fever, things will come back to normal.

04:20 Always make sure that you taper steroids and you teach your patients the importance of that, versus just abruptly -- stopping them 1 day.

04:29 Remember, a patient with an adrenal gland that has been suppressed, if they go through stressors in their life, like, I don't know, nursing school, or moving, or divorce, or death, or marriage, you never know what it is.

04:44 They might need some extra steroids to deal with those cycles.

04:49 They might need some extra steroids to deal with those stressors.

04:53 And don't rule out psychosocial things or physical events or pregnancy.

04:58 Stress is what your patient perceives it to be.

05:02 All right.

05:03 1 more chance for you to see how you're doing.

05:05 You supercharge your memory.

05:06 This is a great exercise.

05:09 Don't look at your notes.

05:12 What you want to do is see, list from head to toe, the symptoms of Cushing's and on the other side, list the symptoms of Addison's.

05:20 Keep in mind they're exact opposites or mere images of each other.

05:26 Ready?