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Relative Adrenal Insufficiency in the Critical Care Setting: Debunking the Classic Myth.
MedLine Citation:
PMID:  21533963     Owner:  NLM     Status:  Publisher    
BACKGROUND: Classic teaching states that chronic adrenal insufficiency is associated with hyponatremia, hyperkalemia, hypercalcemia, hypoglycemia, and eosinophilia. We hypothesize that these diagnostic markers do not predict relative adrenal insufficiency (RAI) in the critically ill or injured patient. METHODS: Chart review of surgical, trauma, and medical patients admitted over 7 years to a critical care unit was performed to evaluate cortisol levels drawn for suspicion of RAI, which was defined as a cortisol concentration <25 mcg/dl. Laboratory parameters were defined as hyponatremia <135 mmol/l, hyperkalemia >5.3 mmol/l, hypercalcemia >2.55 mmol/l (10.2 mg/dl), hypoglycemia <3.89 mmol/l (70 mg/dl), and eosinophilia >5%. RESULTS: A total of 212 patients had cortisol levels drawn. Fifty-seven percent were male and their mean age was 59 years. Fifty-three percent had RAI. Average cortisol level was 30.5 μg/dl. No significant differences were seen in mean potassium, sodium, calcium, or glucose levels between RAI and non-RAI patients. Few patients had laboratory values consistent with RAI. In fact, many with RAI had opposite findings: 75% had hypernatremia, 90% had hypokalemia, 100% had hypocalcemia, and 97% had hyperglycemia. Eosinophilia was statistically significant (P = 0.026). CONCLUSION: Hyponatremia, hyperkalemia, hypercalcemia, and hypoglycemia do not predominate in RAI and laboratory values are of minimal value in predicting patients with RAI.
Fatuma Kromah; Alan Tyroch; Susan McLean; Harold Hughes; Nina Flavin; Soyoung Lee
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-5-2
Journal Detail:
Title:  World journal of surgery     Volume:  -     ISSN:  1432-2323     ISO Abbreviation:  -     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-5-2     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704052     Medline TA:  World J Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Surgery, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, 4800 Alberta Ave., El Paso, TX, 79905, USA.
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