Question

Maleah Brown is a 46-year-old Caucasian who goes to her primary care provider with a chief complaint of weakness. She tells the nurse that she saw a dermatologist a month ago, because her skin tone showed increased pigmentation. The dermatologist told her to stay away from tanning beds, because she has the type of skin that darkens quickly. She recently returned from a vacation in a very sunny, warm location. She states that she is very concerned about her skin and her extreme fatigue and weakness. During the physical examination, her vital signs are measured as BP 90/68, HR 90, RR 18, and T 98.9ºF. Her skin tone is a golden brown, and all her mucous membranes are golden brown. MB denies using a topical instant tanning lotion. She weighs 110 pounds and is 5 feet, 7 inches tall. She reports that she has lost 15 pounds in the past 5 weeks. Blood tests show a blood glucose of 68, Na 110, and K 5.

1. What pathophysiologic processes could explain the serum levels of glucose, sodium and potassium?

2. MB is diagnosed with primary adrenocortical insufficiency, or Addison’s disease. She is prescribed corticosteroid therapy. What are essential teaching points for dosing schedule, indications for increased doses, emergency administration, and identification of her condition to healthcare personnel?

3. MB is started on corticosteroid replacement therapy. One week later, she is admitted to the emergency department with hypotension, dehydration, weakness, lethargy, vomiting, and diarrhea. What is the most probable cause of these signs and symptoms?

4. Which treatment measures are likely to be used to resolve the cause of MB’s signs and symptoms?

Answer 1

1)Because mineralocorticoids stimulate sodium reabsorption and potassium excretion, deficiency results in increased excretion of sodium and decreased excretion of potassium, chiefly in urine but also in sweat, saliva, and the gastrointestinal tract. A low serum concentration of sodium (hyponatremia) and a high concentration of potassium (hyperkalemia) result.Glucocorticoid deficiency contributes to hypotension and causes severe insulin sensitivity and disturbances in carbohydrate, fat, and protein metabolism. In the absence of cortisol, insufficient carbohydrate is formed from protein; hypoglycemia and decreased liver glycogen result.

2) It is considered best to take corticosteroids in the morning as this is when the body usually produces the . Plenty of fluids should b taken. The adverse effects are educated to pt and if there are any sign of adverse effect rush to hospital

3) Most probable cause of these symptoms is hyponatremia, corticosteroids exacerbate the natriuresis-driven diuresis and possibly worsen hyponatremia.

4) serious symptomatic hyponatremia, the first line of treatment is prompt intravenous infusion of hypertonic saline