Fludrocortisone

INTRODUCTION

Indications

Sodium loss and hypotension associated with adrenocortical insufficiency (given with hydrocortisone or cortisone). Management of sodium loss due to congenital adrenogenital syndrome (congenital adrenal hyperplasia). Unlabeled Use: Idiopathic orthostatic hypotension (with increased sodium intake). Type IV renal tubular acidosis.

Action

Causes sodium reabsorption, hydrogen and potassium excretion, and water retention by its effects on the distal renal tubule. Therapeutic Effects: Maintenance of sodium balance and blood pressure in patients with adrenocortical insufficiency.

Adverse Reactions/Side Effects

CNS: dizziness, headache. CV: CHF, arrhythmias, edema, hypertension. GI: anorexia, nausea. Endo: adrenal suppression, weight gain. F and E: hypokalemia, hypokalemic alkalosis. MS: arthralgia, muscular weakness, tendon contractures. Neuro: ascending paralysis. Misc: hypersensitivity reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Watch for signs of congestive heart failure, including dyspnea, rales/crackles, peripheral edema, jugular venous distention, and exercise intolerance. Report these signs to the physician immediately.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension).

• Monitor and report signs of low potassium levels (hypokalemia) or hypokalemic alkalosis. Signs include headache, lethargy, cardiac arrhythmias, and muscle dysfunction (muscle weakness, aches, cramps). Notify physician immediately if these signs occur.

• Report signs of adrenal suppression, including hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, and restlessness.

• Watch for weakness in the lower extremities that migrates progressively toward the trunk, arms, and neck (ascending paralysis). Report these symptoms to the physician immediately.

• Be alert for signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Assess any joint pain, tendon contractures, or other muscle abnormalities to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight gain or increased body fat.

Interventions

• Because of an ...