20 yr old male with adrenal crisis with secondary adrenal insufficiency with iatrogenic cushings syndrome


CC -20 year old male came to casuality with c/o Giddiness since 1week, SOB on exertion since 2days with nausea and vomiting

HOPI- patient was apparently asymptomatic 1week ago then he doveloped giddiness which was sudden in onset no aggravating factors relieved on consumption of food. Later he doveloped SOB 2 days ago with no aggravating and reliving factors along with nausea and vomiting with consumption of food as aggravating factor.

PAST HISTORY- K/C/O cushings syndrome

PERSONAL HISTORY-
occupation -student
Mixed diet
appetite -normal 
bowel and bladder - Normal
no addiction 

FAMILY HISTORY - not significant 

PHYSICAL EXAMINATION-
no pallor, icterus, cyanosis, clubbing, dehydration 

VITALS-
temperature - afebrile 
pulse rate - 80 bpm 
RR - 12 cpm 
BP - 80/50 mm hg 
SPO2 - 98 on RA 
GRBS - 117.mg %

SYSTEMIC EXAMINATION-
CVS-S1 ,S2 heard ,no murmurs 
RS -BAE +
 P/A - soft ,non tender 
CNS -
speech - normal 
 power 
U.L - 5/5 
L.L - 3/5 at presentation in opd ,now 4/5 
TONE - normal 
REFLEXES 
KNEE - + 
BICEP - + 
TRICEP-+
ANKLE - + 
BRACHIORADIALIS - + 
PLANTAR - withdrawal

CLINICAL DATA :
Old image :
Recent images:
Dermatology referral
21/1/22:
22/1/22:
PROVISIONAL DIAGNOSIS-
Adrenal crisis (Distributive shock secondary to adrenal insufficiancy)

TREATMENT -
1) INJ NORAD 2amp in 46ml NS infusion @             0.02mcg/kg/min if BPis low 
2) INJ HYDROCORTISONE 100mg/iv/od
3) INJ  PANTOP 40mg/iv/od
4) INJ ZOFER 4mg/iv/tid
5)IVF NS,RL,DNS-100ml/hr
6)BP charting PR/Spo2/Temp charting
    GRBS 8th hrly

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