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Adrenal crisis — ABEM Board MCQ

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HardRenal/Metabolic emergenciesAdrenal crisisABEM Board

A 45-year-old woman on chronic prednisone arrives with vomiting and weakness after stopping steroids. Triage acuity is ESI 1; BP 72/40 mm Hg, HR 134/min. Sodium is 124 mEq/L, potassium 5.9 mEq/L, and glucose 54 mg/dL. Skin is diffusely hyperpigmented. Which of the following is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Give IV hydrocortisone with isotonic fluids and dextrose as needed

Adrenal crisis requires immediate stress-dose hydrocortisone and resuscitation with fluids and correction of hypoglycemia.

Reference: Endocrine Society adrenal insufficiency guidance