Adrenal Crisis in Emergency Medicine Follow-up

  • Author: Kevin M Klauer, DO, FACEP; Chief Editor: Erik D Schraga, MD   more...
 
Updated: Dec 16, 2009
 

Further Inpatient Care

Inpatient care of adrenal insufficiency should consist of the following:

  • Employ supportive measures as necessary.
  • Correct electrolyte abnormalities.
  • Perform judicious volume resuscitation.
  • Continuously monitor and administer glucose.
  • Once the patient stabilizes, usually by the second day, the corticosteroid dose may be reduced and then tapered. Oral maintenance can usually be achieved by the fourth or fifth day.
  • Mineralocorticoid administration is not needed unless a corticosteroid with low mineralocorticoid activity (eg, dexamethasone) is used, or cortisol/corticosteroid administration has been reduced to near maintenance levels. Mineralocorticoid administration is usually not necessary for treatment of secondary adrenocortical insufficiency.
  • Pursue and manage precipitating factors of adrenal crisis or insufficiency. Infectious etiologies commonly precipitate adrenal crisis. Recognition and treatment of causative factors are crucial aspects of managing adrenal hypofunction.
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Further Outpatient Care

  • Maintenance of cortisol levels may be achieved by administering hydrocortisone 15-20 mg orally (PO) every morning and 5-10 mg PO between 4:00-6:00 PM every afternoon.
  • Maintenance mineralocorticoid levels may be achieved by administering 9alpha-fluorocortisol 0.05-0.1 mg every morning. (This treatment is necessary only for primary adrenocortical insufficiency.)
  • Periodically assess blood pressure, body weight, and electrolytes.
  • Advise patients to increase their cortisol dosage during times of physical stress.
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Contributor Information and Disclosures
Author

Kevin M Klauer, DO, FACEP  Assistant Clinical Professor, Michigan State University College of Osteopathic Medicine; Director, Quality and Clinical Education, Emergency Medicine Physicians, Ltd; Director, Center for Emergency Medical Education; Editor-in-Chief, Emergency Physicians Monthly

Kevin M Klauer, DO, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Howard A Bessen, MD  Professor of Medicine, Department of Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Program Director, Harbor-UCLA Medical Center

Howard A Bessen, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

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