What is the recommended initial treatment for adrenal crisis?

What is the recommended initial treatment for adrenal crisis?

• A. Insulin infusion
• B. Lipid therapy
• C. Hydrocortisone 100 mg IV bolus with fluids
• D. Oral rehydration

Answer: (C)

Adrenal crisis is a medical emergency where the body cannot mount an adequate cortisol response, leading to shock and severe dehydration. The first priority is both substituting the missing glucocorticoid and restoring circulating volume. The best initial treatment is a rapid IV bolus of hydrocortisone, 100 mg, followed by aggressive fluid resuscitation with isotonic saline. Hydrocortisone is ideal here because it provides both glucocorticoid effects and some mineralocorticoid activity, which helps with vascular tone and sodium and water retention during acute stress. Begin with normal saline to correct volume depletion and support血 pressure, then continue with corticosteroid replacement as you monitor the patient. Oral rehydration or slower oral intake would not be sufficient in the unstable, acutely decompensated state, and other therapies like lipid infusions or insulin infusions do not address the underlying cortisol deficiency in this crisis.

Adrenal crisis is a medical emergency where the body cannot mount an adequate cortisol response, leading to shock and severe dehydration. The first priority is both substituting the missing glucocorticoid and restoring circulating volume. The best initial treatment is a rapid IV bolus of hydrocortisone, 100 mg, followed by aggressive fluid resuscitation with isotonic saline. Hydrocortisone is ideal here because it provides both glucocorticoid effects and some mineralocorticoid activity, which helps with vascular tone and sodium and water retention during acute stress. Begin with normal saline to correct volume depletion and support血 pressure, then continue with corticosteroid replacement as you monitor the patient. Oral rehydration or slower oral intake would not be sufficient in the unstable, acutely decompensated state, and other therapies like lipid infusions or insulin infusions do not address the underlying cortisol deficiency in this crisis.