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Drug fever — ABIM Board MCQ

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ModerateGeneral Internal MedicineDrug feverABIM Board

A 62-year-old with autoimmune adrenal insufficiency presents after gastroenteritis with hypotension, vomiting, confusion, sodium 124 mEq/L and potassium 6.0 mEq/L. Blood is drawn for cortisol and ACTH. What must happen next?

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Correct answer: B — Give parenteral hydrocortisone and rapid isotonic-fluid resuscitation

The best answer is “Give parenteral hydrocortisone and rapid isotonic-fluid resuscitation”. This is adrenal crisis. Immediate parenteral hydrocortisone and isotonic fluid are life-saving and must precede confirmatory results; dextrose is added when hypoglycemia is present. Mineralocorticoid alone does not replace stress glucocorticoid, and correcting potassium without treating cortisol deficiency leaves shock and metabolic derangement unresolved.

Reference: Endocrine Society Primary Adrenal Insufficiency Guideline: https://www.endocrine.org/clinical-practice-guidelines/primary-adrenal-insufficiency