Hyperkalemia is higher than normal levels of potassium in the blood stream. This may be due to an increase in total body potassium. Although Hyperkalemia occurs without any symptoms, rarely one can detect signs of irregular heartbeat, nausea, slow, weak or absent pulse, cardiac arrest. Emergency treatment becomes imperative if potassium is high or if symptoms are present, including changes in the ECG. Hospitalization and close monitoring are required.
Addison's disease also known as chronic adrenal insufficiency is a hormonal disorder characterized by tissue necrosis and granulomatous appearance. Addison's disease occurs to people irrespective of age and gender. Addison's disease is also known as hypocortisolism as it is associated with insufficient production of cortisol from the adrenal glands.
Cortisol belongs to the class of glucocorticoid hormones. They are released from the cortex of the adrenal glands located on top of the kidneys. Cortisol has a significant function in the body and is associated with main organ system functions in maintaining the homeostasis in the body. Cortisol is essential in protein, carbohydrate and fat metabolism. It also helps in the regulation and release of insulin for blood sugar balance.
The other important functions of cortisol include maintenance of blood pressure, cardiovascular activity and inflammatory response process associated with the immune system. The level of cortisol in the body is used as a determination of stress management. Cortisol has precursors for its release such as the adrenocorticotropic hormone released due to the stimulus associated with the hypothalamus and pituitary gland.
Addison's disease etiology is predominantly based upon the function of the adrenal gland and the release of cortisol regulated by the pituitary gland. Insufficient cortisol production may be due to impairment of adrenal glands which is categorized as the primary phase in Addison's disease occurrence. The secondary factors are associated with release of adrenocorticotropic hormone levels from the pituitary gland to stimulate the adrenal gland. The tertiary factors are associated with insufficient release of corticotrophin releasing hormone from the hypothalamus.
Significant clinical manifestations include anorexia, vomiting, hypoglycemia, weight loss, cutaneous and mucosal pigmentation, hypernatremia, hyperkalemia, hypotension caused due to extra cellular fluid loss. Excess melanin production is observed along with visible changes in the surfaces of lips and buccal mucosa. Addison's disease can also occur because of preexisting factors such as tuberculosis, histoplasmosis, coccidioiodomycosis , autoimmune diseases and conditions associated with bilateral metastases, hemorrhages, amyloidosis and adrenoleukodystrophy.
Diagnosis of Addison's disease
Addison's disease is diagnosed by clinical symptoms which are correlated with biochemical laboratory tests. The levels of sodium, potassium and other important parameters with respect to inflammatory response and hormonal levels can diagnose the presence of Addison's disease. One of the significant diagnostic tools used to detect the presence of Addison's disease is the ACTH (adrenocorticotropic hormone stimulation test). In this test, ACTH is given intravenously to the patient and the levels of cortisol in urine and blood are examined. This test determines adrenal insufficiency factor.
Addison's disease and pregnancy
Steroid hormone balance and support aids labor and fetal development. Insufficiency of steroid hormones can affect the pregnancy especially during a cesarian. Conditions associated with Addison's disease may increase under situations of emergency. This is because of lack of steroid production in the body. Symptoms such as colds, confusion, increased weakness and fatigue can occur; which may become fatal if untreated.
Diet for Addison's disease
Patients with Addison's disease express cravings for salty food or foods that have citrus flavor. Sufficient intake of proteins balanced with vitamins and minerals is advisable. Many patients suffer dehydration; hence increased fluid intake is advised. Diet patterns can be altered in patients having conditions such as diabetes, hypertension and osteoporosis.
Treatment for Addison's disease
Hydrocortisone and fludrocortisone are generally used to replace the cortisol and aldosterone hormones in cases of adrenal insufficiency. Other options used are prednisone, dexamethasone with slow and sustained release characteristics. The advisable dosage for these steroid hormones is thrice a day to meet with the energy demands and activity of the individual.
Salicylates are part of most medications. Many studies indicate the amount of salicylates-associated morbidity is on the rise in the contemporary scenario as most drugs prescribed contain it as an ingredient and also aspirin misuse. The applications containing salicylates are mostly of analgesic origin. Many forms of salicylates are available in the market as capsules, tablets, solutions and also topical creams.
Toxicity and Clinical manifestations
Salicylate toxicity is one of the primary cases in emergency medicine as it involves organ damage and many other metabolic disorders such as arrhythmia, tachycardia and liver damage. Medical and palliative care is necessary for effective prophylaxis and recovery. Some of the challenges physicians face in case of salicylate overdose is the elimination of the drug before it gets absorbed totally and causes organ damage.
Salicylate poisoning follows a chronology of events before it gets worse. The initial signs include gastrointestinal disturbance and irritation causing vomiting and sustained nauseating feeling. Prolonged effects of these drugs include metabolic acidosis and ketone body formation in the blood leading to alkalosis in case of lung involvement. Dehydration is one of the signs of salicylate toxicity followed by biochemical changes such as increased potassium levels, which causes variations in the nerve signal conduction in relation to the action potential. The hyperkalemia thus caused has a direct influence on the central nervous system.
In addition to disturbed physiologies, renal failure, cardiac disorders, altered breathing rate, tinnitus and loss of hearing is caused since the neurophysiology is also effected causing extensive damage to the neurons because of altered metabolic pathways. Withdrawal from salicylates can also cause adverse effects such as non-cardiac pulmonary edema especially in elderly and hypoglycemia and electrolyte depletion in children and adults. The adverse reactions due to salicylate poisoning are coma, syncope and convulsions.
Management and treatment
Salicylate overdose has no defined remedy. The best option is to clear the gastrointestinal lavage to prevent the drug from being absorbed into the blood stream, which may induce organ damage and central nervous system damage. It is essential to manage salicylate overdose in order to avoid cardiovascular and CNS (central nervous system) damage. Alternate measures of treatment and management include administration of electrolytes and incorporating urine alkalization to prevent kidney damage and acidosis of the urinary tract. Thymine and glucose infusion are essential to help the patient to recover from hypoglycemia.
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Bibliography / Reference
Collection of Pages - Last revised Date: August 6, 2020