[Michigan RN]

No, adrenal crisis. Patients with adrenal crisis present with hyper or hypothermia, unexplained shock refractory to fluid resuscitation.

[poppy07]

Medical diagnosis of the "adrenal crisis" in which there is an insufficiency is Addisonian Crisis, girl! : )

[Michigan RN]

eh, duh. Sorry, thinking something different.

[poppy07]

only thing is, pt had normal Na+(not low), and low (not high) K+ --the opposite if the case was Addisonian crisis

[poppy07]

anyways, what cases are better to give LR vs. NS for boluses? How about Hetastarch vs. Hespan? I've not given either of these yet.

[Michigan RN]

I've never given hetastarch before. Usually give LR or NS.

[poppy07]

My best guess was that the pt had decreased preload, considering the edema and especially low diastolic B/P. Anyone else have suggestions?

[sarahrain]

As we can see the albumin is only 1.5, the reduction of oncotic pressure may further dry the patient intravascularly. The doctor should consider giving albumin to temporary bring up the level. However, the underlying cause should be pinned.

I would also ponder the following..
1. Septic workout
2. Coag profile to rule out DIC..
3. An ABG.. chances of acidosis?
4. HGT level?
5. Likely to be adrenal insufficiency.. secondary to infection.
6. Any echogram done?
7. How is the LFT?

As I can see that the levo was tirated from 5 to 2 then up to 15.. could it be too fast cutting it down? I hope we have CVP reading here.

[EricEnfermero]

Originally Posted by poppy07

How about Hetastarch vs. Hespan? I've not given either of these yet.

Should be the same thing unless my memory is failing me. I'm snooping in here tonight as I'm not an adult critical care nurse, but I used to give Hespan during apheresis procedures (granulocyte donations) at the blood donor center where I worked prior to becoming a nurse.