Page 230 - Critical Care Notes

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ENDO
■ CBC, serum electrolytes and chemistries, BUN and creatinine
■ Serum thyroid levels
■ Urine, sputum, and blood cultures if infection suspected
■ CT scan or ultrasound of the adrenal glands
Management
■ Assess vital signs and hemodynamic parameters as indicated. Consider
vasopressors.
■ Assess respiratory status and oxygenation.
■ Assess for arrhythmias.
■ Weigh daily.
■ Strictly monitor intake and output and renal function.
■ Monitor serum electrolytes and glucose levels frequently.
■ Administer cortisol replacement medications (hydrocortisone IV).
■ Insert nasogastric tube if vomiting.
■ Reorient and minimize stress.
■ Provide small, frequent meals and nutritional supplements.
■ Administer aggressive fluid and electrolyte therapy.
CAUTION: Patients with Addison’s disease should not receive insulin because
of resultant hypoglycemia.
Thyroid Storm
Thyroid storm is a rare, life-threatening complication of a severe form of hyper-
thyroidism that is characterized by high fever, extreme tachycardia, and altered
mental status. It is precipitated by stress and usually has an abrupt onset. Also
called thyrotoxic crisis or thyrotoxicosis.
Pathophysiology
Thyrotropin-releasing hormone (TRH) is released from the hypothalamus after
exposure to stress → the pituitary gland releasing thyroid-stimulating hormone
(TSH) → causes the release of thyroid hormone (T 3 and T 4 ) from the thyroid
gland → T 3 active form of thyroid hormone → increased levels of thyroid hor-
mone leading to hyperthyroidism or thyrotoxicosis → if precipitated by stress
(surgery, infection, trauma, DKA, heart failure, pulmonary embolism, toxemia of
pregnancy, thyroid hormone ingestion, radioiodine therapy, discontinuation of
antithyroid), further increase in serum thyroid hormone → thyroid storm. Can
lead to vascular collapse, hypotension, coma, and death.

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