Perioperative development of Acute Adrenal Insufficiency: A Case Report

Öz

Case: A 60-year-old female patient presented to the emergency room with complaints of abdominal pain, nausea and fever. On examination, she was conscious and and cooperative. The temperature was 38.5°C, Glasgow Coma Score 14, blood pressure 135/82 mmHg, heart rate 74bpm, SpO2 97%. The patient was diagnosed with an acute abdomen and referred for an emergency operation. At 35 minutes, the patient developed hypotension (65/34 mmHg), which did not respond to the administration of adequate fluid support and vasoactive-inotropic agents. Blood-gas analysis showed hypoglycemia (50 mg/dl), hyponatremia, and hyperchalemia, which suggested acute adrenal insufficiency. In addition to fluid support and vasoactive-inotropic agents, methylprednisolone (150 mg) and 20% dextrose were initiated. The hemodynamic status of the patient improved and operation was successfully completed.Preoperative anesthetic evaluation should include the history of previous drug use, in particular steroid use. Anesthesiologists should be alert to the signs and symptoms of acute adrenal insufficiency

Anahtar Kelimeler

• intraoperative hypotension,adrenal crisis,acute adrenal insufficiency

Ameliyat esnasında gelişen Akut Adrenal Yetmezlik: Olgu Sunumu

Öz

Olgu: 60 yaşında kadın hasta; karın ağrısı, kusma ve ateş şikayetleriyle acil servise başvurdu. Muayenesinde bilinç açık, koopereydi. Ateş 38.5C, Glaskov koma skoru 14, kan basıncı 135/82 mmHg, kalp atım hızı 74/dakika, SpO2 %97 idi. Hasta akut batın tanısıyla acil operasyona alındı. Operasyonun 35. Dakikasında yeterli sıvı desteği ve vazoaktif-inotrop ilaçlara yanıtsız hipotansiyon (65/34) gelişti. Kan gazında gözlenen hipoglisemi (50mg/dl), hiponatremi ve hiperpotasemi Akut Adrenal Yetmezliği  destekledi. Hastaya ek olarak metilprednizolon (150 mg) ve %20 Dekstroz başlandı. Hemodinamik olarak düzelen hastanın operasyonu başarılı bir şekilde tamamlandı. Sonuç olarak; preoperatif anestezik değerlendirme ilaç kullanımı ve özellikle steroid ilaçları içermelidir. Anesteziyologlar, Akut Adrenal Yetmezlik belirti ve semptomlarını gözden kaçırmamalıdırlar.

Anahtar Kelimeler

• intraoperatif hipotansiyon,adrenal kriz,akut adrenal yetmezlik

Kaynakça

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