Lab Case 108 – Interpretation

A critically unwell 17 year old with shock and sepsis

  1. 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

  1. 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)

  1. Immediate life threats:

Severe hypoglycaemia




Cortisol deficiency

  1. 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