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Addisonian crisis — SCE Acute Medicine MCQ

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EasyAcute Renal and Metabolic EmergenciesAddisonian crisisSCE Acute Medicine

A 55-year-old woman presents with vomiting, weakness, confusion or collapse. Relevant history includes diabetes, kidney disease, endocrine disease or a treatment trigger. On assessment, volume status and bedside physiology are abnormal. Investigations show shock, hyponatraemia, hyperkalaemia and hypoglycaemia after steroid omission. What is the most important immediate action?

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Correct answer: A — Give intravenous hydrocortisone and isotonic saline immediately

The key discriminator is that shock, hyponatraemia, hyperkalaemia and hypoglycaemia after steroid omission, which makes Give intravenous hydrocortisone and isotonic saline immediately the single best answer. Perform immediate decompression is less appropriate because it does not address the dominant acute risk in the vignette; Activate the major haemorrhage protocol would fit a different presentation or later stage of care. Give broad-spectrum intravenous antibiotics within one hour and Give hypertonic saline bolus are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: Society for Endocrinology adrenal crisis guidance