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Cardiac arrest in an infant with congenital adrenal hyperplasia
W Ruppen1, N Hagenbuch, M Jöhr
1Department of Anaesthesia, Kantonsspital, Luzern, Switzerland.
Insights
A 3-month-old infant
Area of Science:
- Pediatric Cardiology
- Pediatric Endocrinology
- Neonatal Resuscitation
Background:
- Congenital adrenal hyperplasia (CAH) is a group of genetic disorders affecting the adrenal glands.
- Adrenal insufficiency can lead to life-threatening electrolyte imbalances, including hyperkalemia.
- Hydrocortisone is a common treatment for adrenal insufficiency.
Observation:
- A 3-month-old boy experienced an out-of-hospital cardiac arrest.
- The infant was receiving hydrocortisone treatment, suggesting potential adrenal insufficiency.
- Parents did not initially disclose the infant's diagnosis of congenital adrenal hyperplasia.
Findings:
- Hyperkalemia secondary to adrenal insufficiency was suspected as the cause of cardiac arrest.
- Administration of calcium during resuscitation led to the return of spontaneous circulation.
- Prompt recognition and treatment of hyperkalemia were crucial for patient survival.
Implications:
- This case highlights the critical need for thorough parental medical history during emergencies.
- Hyperkalemia should be considered in infants presenting with cardiac arrest, especially those on corticosteroid therapy.
- Early diagnosis and management of congenital adrenal hyperplasia are vital to prevent severe complications.
Abstract:
We report a 3-month-old boy who suffered an out-of-hospital cardiac arrest. During resuscitation, the medical team was informed that he was receiving hydrocortisone treatment. The possibility of adrenal insufficiency with hyperkalemic cardiac arrest prompted the administration of calcium, which resulted in the return of spontaneous circulation. The infant's diagnosis of congenital adrenal hyperplasia was not spontaneously mentioned by the parents. This case illustrates the importance of obtaining adequate parental information and considering hyperkalemia as a possible cause of cardiac arrest.