adrenal crisis, an acute, life-threatening state of profound adrenocortical insufficiency in which immediate therapy is required. It is characterized by glucocorticoid deficiency, a drop in extracellular fluid volume, and hyperkalemia. Also called addisonian crisis. See also Addison’s disease, adrenal cortex. ▪ OBSERVATIONS: Typically, the patient appears to be in shock or coma with a low blood pressure, weakness, and loss of vasomotor tone. The person’s medical history may include abrupt discontinuation of exogenous steroids or Addison’s disease or reveal symptoms indicating its presence. Results of laboratory tests show hyperkalemia and hyponatremia. ▪ INTERVENTIONS: An IV isotonic solution of sodium chloride containing a water-soluble glucocorticoid is administered rapidly. Vasopressor agents may be necessary to control hypotension. If the patient is vomiting, a nasogastric tube is inserted to prevent aspiration and relieve hyperemesis. Total bed rest and monitoring of blood pressure, temperature, and other vital signs are essential. After the first critical hours, the patient is followed as for Addison’s disease, and corticosteroid dosage is tapered to maintenance levels. Infection and a failure to increase the maintenance glucocorticoid (steroid) dose are common causes of crisis in people who have Addison’s disease. ▪ PATIENT CARE CONSIDERATIONS: Nursing care during adrenal crisis includes eliminating all forms of stimuli, especially loud noises or bright lights. The patient is not moved unless absolutely necessary and is not allowed to perform self-care activities. If the condition is identified and treated promptly, the prognosis is good. Discharge instructions include a reminder to the patient to seek medical attention in any stressful situation, whether physiological or psychological, to prevent a recurrence of the crisis.
