Syndrome Waterhouse - Friderichsen: pathogenesis, emergency care, treatment

The Adrenal glands in the body are important endocrine organ. The hormones produced by them affect the pressure and amount of circulating fluid, the level of mineral salts and certain trace elements, rate of metabolism, even in the pituitary gland. And in situations when the function of these small but important glands suffer develop the condition, threatening life and health.

Definition and history

The Syndrome Waterhouse - Friderichsen – acute adrenal insufficiency, which occurs after trauma to the body with hemorrhage in the parenchyma. This causes very severe violations of the constancy of the internal environment of the body and can lead to death.

Description of this condition appeared for the first time in 1894, but it was inadequate, and in 1911 Waterhouse has allocated fifteen cases of the disease, which helped him to piece it all together. Keeping up with him, seven years later, in 1918, Frederiksen has also published an essay about this pathological process.

Causes

Scientists agree that the syndrome Waterhouse - Friderichsen called a massive hemorrhage at the same time in both adrenal glands. A potentially dangerous contingent is newborns, babies, children and young people. Gender in this case does not matter. This condition can be triggered by prolonged childbirth, oxygen starvation of the fetus or its promotion through the birth canal with forceps or vacuum extractor. In addition, the important role of the severe congenital disease, and pregnancy complications of late gestosis.

Recommended

A tablet from worms – the relevance of the application for the person

How relevant today, drugs against worms in humans? What kind of creatures these worms, what are modern methods of treatment? We will try to answer these questions, since ignorance in this area is undesirable. Imagine a mummy, which is misleading in k...

What to do if you cracked skin on hands?

Each of us at least once in a lifetime encounter with a small, but very, when the crack the skin on the hands. At this time there are wounds of different sizes, which hurt and cause inconvenience, especially when in contact with water or detergents. ...

Spray Macho man - the key to a proper relationship between the two spouses

Male impotence is a pathological condition associated with abnormal physiological capacity of the penis to reginout and bring sexual partner pleasure in bed.sex impotenceimpotence may not men to pass unnoticed – it usually spoils his nervous sy...

The Syndrome Waterhouse - Friderichsen in adults is most often seen as a complication of infectious diseases. Usually the causative agent is meningococcus, Streptococcus or Staphylococcus. But in addition to them, the causes of hemorrhage can be such disease, as measles, scarlet fever, typhoid, diphtheria, and malignant neoplasms, tumors, peritonitis and disseminated intravascular coagulation syndrome with thrombosis of the veins of the adrenal glands.

Disease progression

Many authors distinguish this syndrome as part of the overall failure of the adaptation mechanism with the development of acute sepsis. But it is possible that in young children and pregnant completely different mechanism by which develops the syndrome Waterhouse - Friderichsen. Pathogenesis it is evident in the numerous hemorrhagic necrosis in the adrenal cortex. They are so numerous that the whole body soaked with blood, is the hyperextension of the capsule and even rupture.

As for the shared pathogenesis, it is manifested in the form of sepsis.

- dilated capillaries and arterioles;
- a distinct syndrome of intoxication;
- the presence of concomitant meningitis or meningoencephalitis;
- increase thymus and regional lymph nodes.

Symptoms

The Syndrome Waterhouse - Friderichsen with meningococcal disease may develop suddenly on the background of complete well-being. He is progressing so fast that a person can die within days.

It All starts with excessive anxiety, irritability and headaches. Then join pain in the abdomen, nausea, vomiting and diarrhea. If the pain is too intense, the doctor may suspect a patient with acute surgical pathology. Initially the temperature is low, but just a couple of hours from the onset of the disease she will be 39-40 degrees. Because of the vomiting and diarrhea from the body leave the water and minerals that leads to disruption of the heart, brain and other vital organs. In the end, the person loses consciousness and falls into a coma.

There is another form of the disease, manifested in a sharp drop in blood pressure or collapse. Other symptoms may not be at all. The first is in a stupor, but as hypoxia progresses, you will feel stupor and coma. Dies without regaining consciousness.

The Syndrome Waterhouse - Friderichsen children develop faster than adults, regardless of the cause. Given that their compensatory abilities of the body are rapidly depleted, and many systems and organs are still in the process of formation and development, the result comes before the day of onset of the disease.

Diagnostics

The Syndrome Waterhouse - Friderichsen is developing so quickly that often doctors do not have time to conduct a full survey to understand what is happening with the person. If in the emergency room the doctor on duty suspected the pathology, the treatment starts immediately, and diagnostics joins in the process, because the account goes on the clock.

Laboratory to confirm the diagnosis should be detected in General blood test:

- leukocytosis and shift formula to the left;
- decrease in blood glucose;
- thrombocytopenia and low clotting;
- reduced electrolytes;
- increase nitrogen and blood urea.

However, these indicators are not specific and may indicate a broad spectrum of surgical and somatic diseases. To be sure,it is necessary to carefully collect the anamnesis and carry out a lumbar puncture and to describe the neurological status. But all this is done after stabilization of the human condition.

Differential diagnosis

The Syndrome Waterhouse - Friderichsen should be distinguished from surgical diseases of the abdomen such as acute appendicitis, acute pancreatitis, perforation of gastric ulcer or duodenal ulcer. Be sure the doctor should check for meningeal symptoms, to exclude brain hemorrhage, thrombosis of the cavernous sinus. In the cardiac form of the ECG will help to understand whether a person has a heart attack or not.

Treatment

First and foremost, after diagnosis “syndrome Waterhouse - Friderichsen” you must reimburse the patient was sweating fluids, electrolytes, and insufficiency of adrenal hormones. To do this through the venous access introduced to half a liter of "Hydrocortisone" or 120 mg "Prednisolone", then three grams of a five per cent glucose and five per cent, ten milliliters of ascorbic acid solution. So we will act on the main stages of pathogenesis that cause the syndrome Waterhouse - Friderichsen. Emergency care at the same time improves the rheology of blood, dilutes it, increases the amount of system fluid and increases the pressure. And the substitution of steroid hormones helps to maintain pressure at the desired level.

After you have stabilized hormones continue to be administered intramuscularly: "Hydrocortisone" 50-75 milligrams every six hours, and deoxycorticosterone acetate in ten milliliters three times a day. The need to monitor indicators of pressure and, if necessary, to pin "Epinephrine", "Mezaton", cardiac glycosides.

If the cause of the disease was the infection, such as meningococcal disease, in addition to the basic therapy, the patient is administered antibiotics. As soon as the patient's condition returns to normal, the dose of hormones gradually begin to decrease. It is very important to prepare the body to what it needs to develop their own corticosteroids. It is impossible to abruptly cancel the drugs, it might provoke repeated crises.

It's Important to acknowledge that the patient was the syndrome Waterhouse - Friderichsen. The treatment itself can be dangerous, since excessive flooding of the organism causing systemic edema, including brain edema, and large doses of hormones can trigger mental disorders. It is therefore essential to constantly monitor the patient's condition and adjust the assignment according to its needs.

Forecast

The Syndrome Waterhouse - Friderichsen - extremely severe pathology to identify which is not always possible in time due to the variety of nonspecific symptoms. The outcome depends not only on how well it will behave with the doctor in an emergency situation, but also on the degree of destruction of the adrenal glands and compensatory abilities of the body. Frequent ending this disease is fatal.

Prevention

This is mainly anti-epidemic measures in the hearth of infection in which a patient is diagnosed with meningococcal disease. The doctor revealed such a patient, is obliged to inform the sanitary inspection and isolate the patient. The next three days, a check is made of the contact persons for the presence of the disease and a quarantine in the workplace or educational institution for a period of ten days. As prevention people, close contacts of patients prescribed a short course of antibiotics.

Epidemiology

The Syndrome Waterhouse - Friderichsen, unfortunately, a fairly common pathology. In developed countries the prevalence of meningococcal disease is 1-3 cases per 100 thousand population. And more than half of diseased - children of preschool age. In addition, each decade has seen a rise in the incidence. This is due to the mutation of the pathogen and immunosuppression of the population.

This statistic is likely not true, as many cases remain undiagnosed because of the cross of symptoms. Syndrome Waterhouse - Friderichsen is developing so fast that the doctors do not have time to conduct a sufficient number of tests.