34. Неотложная помощь больному с острой надпочечниковой недостаточностью.

1. Supportive measures

1. Manage patient in the critical care area
2. Supply high-flow oxygen
3. Monitor: ECG, vital signs, pulse oximetry
4. Establish 2 large-bore (14G/16G) peripheral IV lines
5. IV fluids:

• Administer IV 0.9% saline or 5% dextrose-water by raped infusion till hypotension corrected ( usual deficit around 2-3 L )

1. Labs:

• Stat capillary blood sugar

• FBC
• Plasma cortisol and ACTH
• Urea, electrolytes, creatinine( mandatory)
• Look for hyponatraemia, hyperkalaemia, metabolic acidosis, elevated urea, hypoglycaemia
• ABG-Arterial blood gas

1. ECG: look for low-voltage QRS tracing with non specific ST-T wave changes and or changes due to hyperkalaemia, reversible with glucocorticoid replacement.
2. Urinalysis by dipstick reagent and culture and sensitivity if sepsis is suspected.
3.  Correct precipating factors such as infection, Acute MI

2. Drug therapy

• IV 50% dextrose water 40ml to correct hypoglycaemia which may be refractory and require repeated boluses
• IV Hydrocortisone 100mg q 6h. PS: draw blood for plasma cortisol and ACTH before treatment.
• Iv sodium bicarbonate if needed: 50mmoles over 1-2 hours: monitor acid base status with serial ABGs