ICU SAQs · Endocrine & metabolic emergencies
Adrenal crisis — the management
A CICM Second-Part SAQ on the adrenal crisis — the hydrocortisone before the tests, the fluid + dextrose, the treat the trigger.
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Prompt
A 60-year-old on long-term prednisolone for rheumatoid arthritis, now septic, presents with refractory hypotension (MAP 50 despite fluids and noradrenaline), Na 124, K 5.8, glucose 2.8. Outline the management.
Question
A 60-year-old on long-term prednisolone for rheumatoid arthritis, now septic, presents with refractory hypotension (MAP 50 despite fluids and noradrenaline), Na 124, K 5.8, glucose 2.8. Outline the management.
References4ShowHide
- [1]Dineen R, Thompson CJ, Sherlock M Adrenal crisis: prevention and management in adult patients. Therapeutic Advances in Endocrinology and Metabolism, 2019.PMID 31223468
- [2]Martin-Grace J, Tomkins M, O'Reilly MW, et al. Iatrogenic adrenal insufficiency in adults. Nature Reviews Endocrinology, 2024.PMID 38272995
- [7]Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline J Clin Endocrinol Metab, 2016.PMID 26760044
- [11]Martel-Duguech L, Poirier J, Bourdeau I, et al. Diagnosis and management of secondary adrenal crisis. Rev Endocr Metab Disord, 2024.PMID 38411891