A critically unwell 17 year old with shock and sepsis
- Describe and Interpret:
Normal anion gap metabolic acidosis
HCO3 14, BE -4
A Gap 10
Severe hypoglycaemia
Severe hyponatraemia
moderate hyperkalaemia
4 features of a typical Addisonian Crises
Severe renal failure
- Features of Addison’s Crises:
- extreme weakness
- mental confusion
- darkening of the skin
- dizziness
- nausea or abdominal pain
- vomiting
- fever
- a sudden pain in the lower back or legs
- a loss of appetite
- extremely low blood pressure
- chills
- skin rashes
- sweating
- a high heart rate
- loss of consciousness
- Hyperpigmentation;
– Due to increased POMC
– Even in areas not exposed to sun
– Hand creases, Nipple, Buccal Mucosa (pathognomonic)
– Darkening of scars
In this patient is the sepsis secondary to the Addison’s or could he have meningococcal septicaemia with Adrenal haemorrhage (waterhouse-Friedrichsen)
- Immediate life threats:
Severe hypoglycaemia
Shock
Sepsis
hyperkalaemia
Cortisol deficiency
- Treatment:
Correct hypoglycaemia – 50mls 50% dextrose
Fluid rehydration – 0.9% Saline
Antibiotics – broad spectrum cover with CNS peneration (PLEASE NOTE: Vitamen T ie. Tazocin/Timentin may have poor CNS penetration)
Hydrocortisone – 200mg iv
Treat and monitor hyperkalaemia – (Calcium Gluconate, Salbutamol neb, frequent monitoring)
Patient requires invasive monitoring – arterial line, CVC, Vascath for dialysis)
Urgent ICU consult
Look for cause/ source of sepsis and Addison’s