UMEM Educational Pearls

Category: Critical Care

Title: Uncommon Causes of Shock

Posted: 1/24/2023 by Mike Winters, MD (Updated: 9/24/2023)
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An Uncommon Cause of Shock

Sepsis is the most common cause of distributive shock encountered in the emergency department and intensive care unit.
Notwithstanding, it is important to consider other etiologies of shock, especially when the patient is not responding to resuscitation.
Adrenal crisis is one uncommon etiology of distributive shock whereby the diagnosis is often delayed.
Risk factors for adrenal crisis can include recent GI illness, thyrotoxicosis, recent surgery, and physical or psychological stress.
Patients often have nonspecific symptoms of generalized weakness, abdominal pain, vomiting, fever, and altered mental status.
Current guidelines recommend the administration of 100 mg of hydrocortisone in adults suspected of having adrenal crisis.

Narayan S, Petersen TL. Uncommon etiologies of shock. Crit Care Clin. 2022; 38:429-441.