Laboratory values are not consistent, but, hypoglycemia, hyponatremia, and hyperkalemia are often evident in primary adrenocortical insufficiency. The plasma concentration of cortisol is low in a early morning specimen or when the child is stressed. When the child is hospitalized, the nurse monitors the blood pressure and intake and output closely. Accurate and frequent blood pressure measurement is important because hypotension indicates inadequate hormone replacement and electrolyte imbalance. In contrast hypertension may signal excessive replacement.
Hydration is assessed by carefully recording intake and output and by observation of skin turger.
Level of consciousness should be assessed regularly while the child is ill. In times of stress, the normal adrenal gland increases it production of cortisol, and this response must be mimicked in the child with the adrenal insufficiency. A rule of thumb approach is that when a child has a minor illness the cortisol dose should be doubled at at each administration until the child is well. A more serious illness that keeps the child home from school requires a tripling of the dose. Vomiting, accidents, severe fatigue, surgery, and other highly stressful situations produce immediate and intense needs that can be best met with and injection of hydrocortisone.