Adrenal Crisis IM Hydrocortisone — ORE Part 1 MCQ

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ModeratePharmacology & TherapeuticsAdrenal Crisis IM HydrocortisoneORE Part 1

An adult taking prednisolone 10 mg daily long term for rheumatoid arthritis becomes acutely unwell during dental treatment. They collapse, are severely hypotensive, confused and weak. Which drug should be administered immediately?

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Correct answer: D — Hydrocortisone 100 mg intramuscularly

Explanation lettering: B = shown as A · D = shown as B · E = shown as C · A = shown as D · C = shown as E

A is correct. Long-term prednisolone can suppress the hypothalamic–pituitary–adrenal axis. Severe hypotension, confusion and weakness in this context should be treated as suspected adrenal crisis. NICE recommends immediate intramuscular or intravenous hydrocortisone; 100 mg IM is appropriate in a dental setting while emergency transfer is arranged. Intravenous 0.9% sodium chloride is also required in definitive emergency management, but fluids alone do not replace the missing glucocorticoid and are therefore not the best answer. IM adrenaline is indicated for anaphylaxis, not adrenal crisis. Sublingual glyceryl trinitrate may worsen hypotension. Buccal glucose would be inappropriate in a confused collapsed patient and does not treat cortisol deficiency.

Reference: NICE. Adrenal insufficiency: identification and management (NG243), section 1.7, Emergency management of adrenal crisis, 2024 (updated December 2024). https://www.nice.org.uk/guidance/NG243/chapter/recommendations