A 9-year-old boy with hypopituitarism following treatment for a craniopharyngioma takes daily hydrocortisone and levothyroxine. He has had fever and

Question

A 9-year-old boy with hypopituitarism following treatment for a craniopharyngioma takes daily hydrocortisone and levothyroxine. He has had fever and vomiting for 18 hours and has been unable to retain his last two hydrocortisone doses. No emergency injection has been given. In the emergency department he is drowsy but responds to voice. His blood pressure is 76/42 mmHg, capillary refill time is 5 seconds and bedside glucose is 2.3 mmol/L. Sodium is 129 mmol/L and potassium is 4.3 mmol/L. Intravenous access is established. Which management plan is most appropriate now?

Accepted Answer

Give intravenous hydrocortisone 100 mg, 10% glucose 3 mL/kg and 0.9% sodium chloride 10 mL/kg, and admit.

Answer

Give intravenous glucose and 0.9% sodium chloride, obtain cortisol and ACTH results before intravenous hydrocortisone, and admit.

Answer

Give intravenous hydrocortisone 100 mg and 0.9% sodium chloride 10 mL/kg, reassess glucose after resuscitation, and admit.

Answer

Give oral hydrocortisone 100 mg, intravenous 10% glucose 3 mL/kg and 0.9% sodium chloride 10 mL/kg, and admit.

Answer

Give intravenous hydrocortisone 100 mg, 10% glucose 3 mL/kg and 0.9% sodium chloride 10 mL/kg, and discharge once observations normalise.

Adrenal crisis due to secondary adrenal insufficiency — MRCEM SBA MCQ