Question

A 50-year-old man on chronic prednisone for vasculitis presents with vomiting, hypotension (80/50 mm Hg), abdominal pain and confusion after a recent infection. He is known to have secondary adrenal insufficiency. What is the most appropriate immediate management?

Accepted Answer

Intravenous hydrocortisone 100 mg bolus followed by 200 mg over 24 hours and aggressive intravenous fluids

Answer

Oral hydrocortisone 10 mg twice daily at home

Answer

Stop all steroids to avoid immunosuppression and give only fluids

Answer

Delay steroids until a short synacthen test is completed

Answer

Start fludrocortisone only

Practice question

A 50-year-old man on chronic prednisone for vasculitis presents with vomiting, hypotension (80/50 mm Hg), abdominal pain and confusion after a recent infection. He is known to have secondary adrenal insufficiency. What is the most appropriate immediate management?