Recognise and manage adrenal crisis in a steroid-dependent child — OSCE

A five-year-old girl on long-term prednisolone for frequently relapsing nephrotic syndrome is brought to the emergency department by her parents after two days of fever and vomiting. She is drowsy and peripherally shut down, with a capillary refill of four seconds and a blood pressure of 78/40 mmHg. The bedside glucose is 2.0 mmol/L. You have eight minutes to recognise adrenal crisis, state the immediate management with age-banded stress-dose hydrocortisone, run resuscitation in parallel, and explain the diagnosis and the emergency plan to the family.