title: Treatment of addison disease and subsequent hypophosphatemic respiratory failure.
abstract: A 38-year-old man was found unresponsive with hypoglycemia by emergency medical service (EMS) personnel. He was intubated in the emergency department after reports of seizure activity. With supportive care and empiric steroids, the patient was extubated the next day. He reported a diagnosis of Addison disease and noncompliance with his steroid replacement therapy. Within 12 hours, respiratory failure and altered mental status required reintubation. Laboratory studies revealed rhabdomyolysis and hypophosphatemia. The replacement of glucose likely stimulated glycolysis, formation of phosphorylated glucose compounds, and an intracellular shift of phosphorus. This patient required phosphate replacement and was extubated on hospital day 5. We report a unique case of hypoglycemia due to Addison disease, leading to hypophosphatemic respiratory failure.
authors: Department of Anesthesiology and Critical Care Medicine, George Washington University Medical Center, Washington, DC 20037, USA.
authors: Leah
authors: L
authors: Meisterling
authors: Lakhmir S
authors: LS
authors: Chawla
authors: Michael G
authors: MG
authors: Seneff
mesh_terms: D000224:Addison Disease / Q000628:therapy*; D000328:Adult; D004632:Emergency Medical Services; D020249:Hormone Replacement Therapy; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D007003:Hypoglycemia; D017674:Hypophosphatemia / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D008297:Male; D012131:Respiratory Insufficiency / Q000150:complications; D012206:Rhabdomyolysis / Q000097:blood / Q000175:diagnosis
chemical_list: D006854:Hydrocortisone