Adrenal crisis — DipIMC MCQ

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ModerateMedical EmergenciesAdrenal crisisDipIMC

A 35-year-old with Addison's disease has vomiting, abdominal pain and collapse during a remote walk. He is hypotensive and his partner has an emergency hydrocortisone kit. What is the most appropriate drug/dose?

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Correct answer: C — Give intramuscular hydrocortisone 100 mg if available and transfer urgently

Give intramuscular hydrocortisone 100 mg if available and transfer urgently is the best answer because known adrenal insufficiency with shock and vomiting is adrenal crisis requiring urgent hydrocortisone. Give oral antihistamine as first-line treatment is less appropriate because antihistamines do not treat airway, breathing or circulation compromise; Give intramuscular adrenaline 1 mg is less appropriate because 1 mg intramuscular adrenaline is not the standard anaphylaxis dose. Give intravenous adrenaline 1 mg as a rapid bolus and Give nebulised salbutamol as sole treatment are also suboptimal because they move attention away from the key pre-hospital priority.. The key DipIMC principle is to treat immediate reversible threats, communicate clearly and move the patient toward the right definitive care.

Reference: JRCALC Guidelines; Society for Endocrinology guidance