Addisonian Crisis: Symptoms and Treatment (Nursing)

by Prof. Lawes

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    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?

    About the Lecture

    The lecture Addisonian Crisis: Symptoms and Treatment (Nursing) by Prof. Lawes is from the course Endocrine Medications (Nursing). It contains the following chapters:

    • Why do we talk about Addisonian Crisis
    • Symptoms of Addisonian Crisis
    • Treat Addisonian Crisis

    Included Quiz Questions

    1. Hyponatremia
    2. Hypernatremia
    3. Hyperglycemia
    4. Hypoglycemia
    5. Hypokalemia
    1. Sodium and fluid excretion and potassium retention leading to low blood volume
    2. Sodium and fluid retention and potassium excretion leading to low blood volume
    3. Both sodium and potassium retention leading to fluid excretion and low blood volume
    4. Potassium and fluid excretion and sodium retention leading to low blood volume
    1. Hormone replacement
    2. IV fluid resuscitation
    3. Hypernatremia treatment
    4. Antipyretic medication

    Author of lecture Addisonian Crisis: Symptoms and Treatment (Nursing)

     Prof. Lawes

    Prof. Lawes

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