台灣外科醫學會雜誌

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篇名	Hemodynamic Instability in a Major Burn Patient Associated with Asymptomatic Iatrogenic Adrenal Insufficiency:Report of a Case
作者	Tyng-Luen Roan, Eng-Kean Yeong, Yueh-Bih Tang
卷期/出版年月	44卷1期 (2011/2)
頁次	35-40
摘要	Objective: The purpose of this paper is to draw attention to adrenal insufficiency instead of hypovolumic shock as a possible cause of hemodynamic instability during the early stages of burn resuscitation. Case report: Adrenal insufficiency after a severe burn is uncommon. We recently encountered a 29-year-old male patient with nasopharyngeal cancer who was admitted to our burn center due to a second-to-third degree thermal burn involving 40% of his total body surface area (TBSA). The patient had been receiving radiochemotherapy and was taking dexamethasone (4 mg/day) for post-irradiation brain necrosis and swelling; he had no clinical symptoms of Cushing’s syndrome under this treatment. In the initial phase of fluid resuscitation, the patient showed hemodynamic instability and poor responses to both intravenous fluid challenge and vasopressors. As adrenocorticotropic hormone (ACTH) testing was consistent with adrenal insufficiency, solu-cortef (200 mg/day) was given. Blood pressure then was restored to the normal level without vasopressors.
關鍵詞	adrenal insufficiency, burn
分類	Case Report