Microsoft powerpoint - adrenal insufficientcy and differential [compatibility mode]
Adrenal Glands
• Located bilaterally at the superior pole of each kidney
• Known as as a gland within within a gland Insufficiency
• The Cortex secretes hormones • The Medulla secretes epinephrine Dr. Michael E. O’Brien
• Only the Cortex will be discussed Dr. Frank S. Drongowski Hormones Glucocorticoids
• Glucocorticoids like Cortisol Glucocorticoids like
• They Regulate the carbohydrate, fat,
• Mineralcorticoids like and protein Metabolism Aldosterone
• They inhibit Inflammation IInflammation
• Sex hormones like
• They maintain Homeostasis during Homeostasis Dehydroepiandosterone
• Only the Glucocorticoids will be
• Synthetics of Glucocoricoids are Synthetics used to treat many Inflammatory discussed Diseases Pathophysiology
• Primary Disease which is uncommon
• Patient takes e synthetic steroids is called Addison’s Disease which is called Addison’s any number of inflammatory progressive destruction of the gland diseases the gland the gland
• Since the body has the normal doses Since the body destroyed before there are destroyed symptoms of steroids the adrenal gland steroids the adrenal gland
• Secondary Disease which is the most which is the not produce any and stagnates common and of most concern is
• When the body needs more for stress caused by the Administration of the gland cannot produce more Exogenous Synthetic Corticosteroids Adrenal Insufficiency and DifferentialLocal Anesthesia for Dental Hygienists – Session III
Michael E. O’Brien, DDS and Frank S. Drongowski, DDS
Glucocorticoids Equivalents
• Hydrocortisone (Cortisone) is an example of Short acting
• 25 mg of Cortisone
• 20mg of Hydrocortisone
• Prednisone (Deltasone) is an example of Intermediate acting
• 5 mg of Prednisone
• 0.75 mg of Dexamethasone
• Dexamethasone (Decadron) is an example of Long acting Rule of Twos Consultation
• Very conservative Rule
• The patient’s physician will
• Patient taking Cortisone 20 mg Patient taking Cortisone 20 determine the dose necessary for or more or it’s it’ Equivalent it is necessary s necessar .
• For Two weeks or longer
• He or she will use the current
• Within a Two year period daily dose, length of time, and
• Then consult their physician level of stress associated with the level procedure to determine this. Examples
• Routine procedure with little
• You do not w nt to treat this stress may require current dose emergency or doubling of dose.
• You will probably never see a primary ( (Addison’s)
• Whereas more major procedures
• Be very careful with patients taking may require quadrupling the steroids and always consult their dose or more and may need to be physician multiple days depending on post multiple days depending on post--
• Injected joints Injected or Topicals are not a op period. Adrenal Insufficiency and DifferentialLocal Anesthesia for Dental Hygienists – Session III
Michael E. O’Brien, DDS and Frank S. Drongowski, DDS
Signs and Symptoms Management
• If patient is conscious but
• Weakness and Fatigue showing signs and you know
• Anorexia and Anorexia Weight Loss
• Hyperpigmentation of the Sk Hyperpigmentation from history that it may be Mucous Membranes (only in adrenal i nsufficientc Addison’s)
• Place patient in comfortable
• Nausea and Vomiting position and give them
• Dehydration and Fever hydrocortisone 100 mg IM. hydrocortisone 100
• Hypotension and Hypoglycemia
• This may avert the emergency. Management
• P - Supine with Legs Elevated
• A - Head Tilt and Chin Lift Head Tilt and Chin Lift
• B - (LLF) Give Oxygen (LLF) Give Oxygen
• C – (Signs of) it (Signs of) it -- will be very will be very Management
• D - Definitive Definitive Treatment - Call Unconsciousness 911 because patient will not 911 regain c onsciousness consciousness, monitor Differential Differential vital signs and can give Hydrocortisone 100 mg I.M. if Hydrocortisone 100 Diagnosis available. However patient needs hospitalization and massive doses of steroids I.V. and sugar. Adrenal Insufficiency and DifferentialLocal Anesthesia for Dental Hygienists – Session III
Michael E. O’Brien, DDS and Frank S. Drongowski, DDS
Stress Related
• Child - Hypoglycemia, Epilepsy Hypoglycemia, Epilepsy
• Teen - 40 40 - Psychogenic Reactions
• Vasodepressor Syncope (Vasodepressor S Syncope),
• Hypogl Hypoglycemia (Diabetes), Epilepsy
• Over 40
• Epilepsy - Postural Hypotension, Postural Hypotension, Cardiovascular Problems (Heart
• Cardiovascular Problems Attack, Stroke, e Arrythmia) (Heart Attack and Stroke) Duration of Pallor, Feeling Hot, Unconsciousness Perspiration, and Nausea Perspiration, and
• Postural Hypotension • Vasodepressor Syncope
• Vasodepressor Syncope
• Seizure H poglycemia
• Hypoglycemia
• Myocardial Infarction (cold)
• Adrenal Insufficientcy
• Adrenal Insufficientcy
• If not short and ammonia does
• (Hypotension (Hypotension -- Hypoxia) Hypoxia) not work then Call 911 One Mo Time Unconsciousness
• P - Supine with Feet Elevated Supine with
• A - Head Head Tilt Questions?
• B - (LLF) (LLF) -- Give Oxygen
• C - (Signs of ) Check (Signs of )
• D - Continue Ox Continue Oxygen, Try Spirits Try Spirits Ammonia, and if Still Un if Still U conscious Adrenal Insufficiency and DifferentialLocal Anesthesia for Dental Hygienists – Session III
Michael E. O’Brien, DDS and Frank S. Drongowski, DDS
¿Qué hay de nuevo en lectura remedial? Albert Harris Se realiza en este trabajo un escrutinio de los avances en lectura remedial, con particular atención a los nuevos enfoques en el tratamiento en las áreas terapéuticas médicas, psicológicas y educativas. Terapias médicas El estudio de las dificultades de aprendizaje y la lectura se ha transformado en un esfuerzo inter
Residente de tercer año de Pediatría, HIGA San José de Pergamino Lactante de sexo masculino de dos meses de edad, que ingresa a nuestra sala de Pediatría con diagnóstico de atelectasia masiva. Refiere cuadro de 72 hs de evolución caracterizado por dificultad respiratoria e hiporexia. Antecedentes personales: fruto de un embarazo controlado, G1 P1, parto eutócico, RNT de 40 semanas de ge