Yoğun Bakımda Adrenal Yetmezlik Yönetimi
Özet
Karın ağrısı,halsizlik,bulantı şikayeti ile acil servise başvuran 72 yaşındaki kadın hastaya akut pankreatit teşhisi konuldu.Hastanın takiplerinde genel durumunda gerileme oksijenızasyonda bozulma olması nedeni ile endotrakeal entübe edilerek mekanık ventılasyona bağlı takip edilmeye başlandı.Hasta septik şok tablosunda olması nedeni ile 25cc/kg %0.9 nacl ile intravenöz(İV)hidrate edildi.Meronem 3x1 lınezolıd 2x600 ve 0.1 mcg/kg/dk nörepinefrin başlandı.Nörepinefrin dozu artmasına rağmen hipotansiyon devam eden hastada çalışılan kan tetkıklerınde kortizol 3.06 µg/dl ACTH(adrenokortikotropik hormon) 148.1 pg/mL izlendi. Adrenal yetmezlik tanısı konulan hastaya hidrokortizon başlandı.Takiplerinde normotansif olan hasta mekanik ventilatörden ayrıldı.Hasta oral prednizolon yazılarak servise devir edildi.
A 72-year-old woman was diagnosed with acute pancreatitis when she applied to the emergency room with complaints of abdominal pain, weakness, and nausea. During the follow-up, the patient's general condition decreased and oxygenation deteriorated, and he was followed up with endotracheal intubation and ambient ventilation. Since the patient was in septic shock, he was hydrated intravenously (IV) with 25cc/kg 0.9% NaCl. Meropenem3x1 linezolid 2x600 and 0.1 mcg/kg/min norepinephrine were started. Although the norepinephrine dose was increased, hypotension continued. In the blood tests studied in the patient, cortisol was 3.06 µg/dl and ACTH (adrenocorticotropic hormone) was 148.1 pg/mL. Hydrocortisone was started on the patient, who was diagnosed with adrenal insufficiency. The patient, who was normotensive during follow-up, was weaned off the mechanical ventilator. The patient was transferred to the service with oral prednisolone prescribed
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