Addisons (341/1700)

A 54yo woman has presented with episodes of abdominal ache, vomiting and postural
hypotension. She also has a dark pigmentation of her skin. A dx of Addison’s disease was made.
What is the most likely electrolyte abnormality expected in this pt?

a. High Na+, Low K+
b. Low Na+, High K+
c. Low Na+, Low K+
d. High Na+, High K+
e. Low Na+, Normal K+




























answer: B

• acute condition – can be life-threatening

-        IV NS in large volumes (2-3 L); add D5W if hypoglycemic from adrenal insufficiency

-        hydrocortisone 50-100 mg IV q6-8h for 24h, then gradual tapering

 

-        identify and correct precipitating factors

• maintenance

-        hydrocortisone 15-20 mg total daily dose, in 2-3 divided doses, highest dose in the AM

-        fludrocortisone (mineralocorticoid) 0.05-0.2 mg PO daily if mineralocorticoid deficient increase dose of steroids 2-3 fold for a few days during moderate-severe illness (e.g. with vomiting, fever)

-        major stress (e.g. surgery, trauma) requires 150-300 hydrocortisone IV daily divided into 3 doses