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Adrenal crisis — FRCA Primary MCQ

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EasyPharmacologyAdrenal crisisFRCA Primary

A patient on long-term prednisolone becomes hypotensive with hyponatraemia and hyperkalaemia during emergency surgery. Which drug is most appropriate?

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Correct answer: D — Hydrocortisone

Hydrocortisone treats adrenal crisis with glucocorticoid and mineralocorticoid activity. Ketamine is less appropriate because it would fit a different clinical clue or a separate anaesthetic problem. Protamine is less appropriate because it would fit a different clinical clue or a separate anaesthetic problem. Rocuronium is less appropriate because it would fit a different clinical clue or a separate anaesthetic problem. Bupivacaine is less appropriate because it would fit a different clinical clue or a separate anaesthetic problem. In Primary FRCA pharmacology, link the clinical effect to the receptor, distribution or elimination mechanism rather than memorising isolated facts.

Reference: Peck, Hill & Williams Pharmacology for Anaesthesia and Intensive Care; BNF; Primary FRCA textbooks