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4.2. Acute adrenocortical insufficiency


(Adrenal crisis)
Definition
This is acutely developed, a pronounced discrepancy between the
low levels of adrenal hormones in the blood and increased
the need for them, which is accompanied by extreme
severity of symptoms gipokortitsizm.
Etiology
Sharp expressed infectious-inflammatory processes,
abrupt discontinuation or drastic reduction of the dose
corticosteroids, surgery without correction
replacement therapy, pregnancy, childbirth, alcohol
intoxication, insulin treatment, etc.
Pathogenesis
The pathogenesis is a sharp deficit of corticosteroid
hormones (gluco-and mineralocorticoids). The most common acute
adrenal insufficiency occurs in patients with already
existing primary or secondary adrenal pathology. Here
it is a severe decompensation of chronic adrenal
failure, most often the primary. Due to the wide clinical
use of glucocorticoids often acute
adrenal insufficiency developed in the framework of the heavy
their withdrawal syndrome. Has developed acute shortage of cortical hormones
the adrenal glands leads to a profound disturbance of all kinds of exchange,
decrease in gluconeogenesis, hypoglycemia, decreased CBV, collapse,
severe renal impairment, cardiovascular,
digestive and nervous systems.
The clinical picture
Cardiovascular status: pale face with acrocyanosis
cold extremities, severe hypotension,

tachycardia, thready pulse, anuria, collapse, effects of acute


circulatory failure. Gastrointestinal
(Psevdopvritonealnaya) form: abdominal pain, spastic
nature, constant nausea, uncontrollable vomiting, sometimes with an admixture of
blood, diarrhea, flatulence. Neuropsychiatric
(Meningoentsefalicheskaya) form of headaches, meningeal
symptoms, seizures, focal symptoms, delusions, confusion,
stupor.
Laboratory data
Laboratory data are identical to adrenal crisis
laboratory data of chronic insufficiency of the cortex
adrenal gland (Addison's disease).
Treatment
Massive cortical hormone replacement therapy
adrenal glands. 1.1. Treatment with drugs with combined gluco-and
mineralocorticoid effect (hydrocortisone first
simultaneously in / injected 100 mg, and then during the day introduced more
400 mg I / O). 1.2. Co-administration of glucocorticoid and
mineralocorticoids: prednisolone 60 mg / in at once, then 120 180 mg I / O during the day and Docks 0.5% -1 ml of n / k Two. Fighting
dehydration and hypoglycemia: sodium chloride 0.9% -2 l / v and glucose
5% -1 l / in the cap. Three. Symptomatic therapy.

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