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Adrenal crisis — SCE Acute Medicine MCQ

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HardDiabetes and endocrine medicineAdrenal crisisSCE Acute Medicine

A 47-year-old man with known Addison's disease presents with vomiting, abdominal pain and collapse after influenza-like illness. BP is 76/42 mmHg, sodium 124 mmol/L, potassium 6.2 mmol/L and glucose 3.0 mmol/L. His steroid card is found in his wallet. What is the most appropriate next step in management?

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Correct answer: A — Give hydrocortisone 100 mg IV immediately with 0.9% sodium chloride resuscitation

This is adrenal crisis with shock, hyponatraemia, hyperkalaemia and hypoglycaemia in known adrenal insufficiency. Hydrocortisone 100 mg IV should be given immediately with isotonic saline and glucose as needed; diagnostic testing must not delay treatment. Hyperkalaemia often improves with steroid and fluid resuscitation, though severe ECG changes would also need direct treatment.

Reference: Society for Endocrinology Adrenal Crisis Guidance; BNF Hydrocortisone