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Refractory collapse and severe burn: Think about acute adrenal insufficiency
Ismail Aissa1, Mohammed Meziane1, Abdelghafour El Koundi1
1Department of Anesthesiology and Intensive Care, Military Hospital Med V, Faculty of Medicine and Pharmacy of Rabat, University Souissi-Med V, Rabat, Morocco.
Introduction:
Adrenal insufficiency (AI) is a rare endocrine disorder, which can in its acute form be life-threatening in case of late diagnosis or treatment. The stress during a thermal burn can easily decompensate the AI. We report the case of an acute adrenal insufficiency (AAI) discovered following a refractory collapse occurred after a severe thermal burn.
Case Presentation:
A 60-year-old woman was accidentally burned to the lower limbs by hot water. Total burn surface area was 36 %. The patient had local care and dressings, vascular filling, and analgesics. Four hours later, she became dyspneic, and presented tachycardia associated with collapse at 60/40mmHg. Suspecting a hypovolemic origin, we performed a solid fluid replacement with colloids. However, hemodynamic stability was not achieved and motivated a continuous injection of norepinephrine. Despite high doses, immediate evolution was marked by a persistent precarious hemodynamic state. AAI was suspected, and a substitutive hormonotherapy was started. The clinical condition progressively improved and catecholamines were quickly stopped.
Conclusion:
AAI is a vital emergency. The large burn is a possible cause of the AI decompensation. This diagnosis must be kept in mind when the hemodynamic status remains unstable despite an adequate vascular treatment.
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