Difference between revisions of "Congenital adrenal hyperplasia"

(Differential Diagnosis)
(Treatment)
Line 23: Line 23:
  
 
==Treatment==
 
==Treatment==
#NS 10-20cc/kg bolus
+
#[[NS]] 10-20cc/kg bolus
 
#Steroid replacement
 
#Steroid replacement
##Neonates: Hydrocortisone 25mg IV/IO
+
#*Neonates: [[Hydrocortisone]] 25mg IV/IO
#Hyperkalemia
+
#[[Hyperkalemia]]
##Do NOT give insulin/glucose (may lead to profound hypoglycemia)
+
#*Do NOT give insulin/glucose (may lead to profound [[Neonatal hypoglycemia|hypoglycemia]])
##NS and hydrocortisone are usually sufficient
+
#*[[NS]] and [[hydrocortisone]] are usually sufficient
##May add calcium gluconate if symptomatic
+
#*May add [[calcium gluconate]] if symptomatic
  
 
==Disposition==
 
==Disposition==

Revision as of 20:40, 25 March 2015

Background

  • 95% of cases due to deficiency of 21-hydroxylase
    • Leads to cortisol deficiency, aldosterone deficiency, virilization
  • Pts present during 2nd-5th week of life in crisis

Diagnosis

  • Pt presents in 2nd week of life in crisis
    • Lethargy, irritability, poor feeding, vomiting, dehydration, shock
  • Salt-wasting
    • Hyponatremia, hyperkalemia
  • Virilization

Work-Up

  • Bedside glucose
  • Chemistry
    • Hyponatremia
    • Hyperkalemia - rarely causes cardiac dysfunction

Differential Diagnosis

  • Adrenal salt-wasting crisis

Sick Neonate

THE MISFITS [1]

Treatment

  1. NS 10-20cc/kg bolus
  2. Steroid replacement
  3. Hyperkalemia

Disposition

Admission

See Also

Source

Tintinalli

  1. Brousseau T, Sharieff GQ. Newborn emergencies: the first 30 days of life. Pediatr Clin North Am. 2006 Feb;53(1):69-84, vi.