Why are we talking about an Addisonian crisis?
Well, Nurse Natalie's probably
expressing your frustration right there.
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.
And now, for some reason, either we fail to give
them to them, or they decided to stop taking them --
We throw them right into an Addisonian crisis.
Their adrenal gland starts acting like
someone who has Addison's disease
because it's been suppressed with the therapy.
And unless you wean the patient
off that medication slowly,
you throw them straight
into an Addisonian crisis.
Remember, the Sugar Daddy Syndrome.
That adrenal gland gets real comfortable,
because it's not getting stimulated at all.
And if you abruptly stop
you'll see the same symptoms that we would
see with someone in Addison's disease
who's not receiving enough
hormone replacement therapy.
So, let's --
I want to see what you can come up with.
You already know Cushing's, we've
discussed that and you've reviewed that.
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.
So before we walk through
these, let's have some fun.
Let's see what you can remember and
apply to an Addisonian crisis,
the opposite of what you see in Cushing's disease.
Now, we just put a lot of the symptoms up there.
Because they're dehydrated,
you're going to see the fever.
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.
Your blood pressure is going to be low.
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.
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.
You have that low volume
because you're dehydrated.
You don't have enough of that aldosterone
available from the adrenal cortex.
Now, low sodium, higher potassium, which is again,
the exact opposite of what we saw in Cushing's.
Blood sugar also going to be low.
So look at these guys as a total picture.
It happens in disease, when we don't
have good replacement therapy.
It happens in our patients
or people who have Cushing syndrome
when, for some reason, they don't
receive their medication either.
Both cases we have adrenal
glands that can't function.
In Addison's disease, it's usually because it's an
autoimmune disorder that knocked out the organ.
In Cushing syndrome, it's because they
abruptly stopped taking their medication.
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.
Now, let's go back and look at that
other slide for just a minute.
What are the biggest problems we have here?
Well, let's start on the right side.
You've got fever.
Okay, well, I can give you Tylenol for that.
I've got low blood pressure
because I've gotten dehydrated.
All right, well, I could give
you some IV fluids for that.
I could probably address that.
Maybe deal with your sodium, and your blood sugar,
I can give you some high carb
food if you can swallow.
Yeah, none of that is going to
work until you do this next thing.
You have to replace the hormones.
You are just trying to fix a problem that you
will never fix until you replace those hormones.
You need to, most importantly, replace those
hormones and do all that other stuff.
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.
Always make sure that you taper steroids
and you teach your patients the importance
of that, versus just abruptly --
stopping them 1 day.
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.
They might need some extra steroids
to deal with those cycles.
They might need some extra steroids
to deal with those stressors.
And don't rule out psychosocial things
or physical events or pregnancy.
Stress is what your patient perceives it to be.
1 more chance for you to see how you're doing.
You supercharge your memory.
This is a great exercise.
Don't look at your notes.
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.
Keep in mind they're exact opposites
or mere images of each other.