1. IV normal saline
2. IV hydrocortisone 100 mg stat
3. IV 10% glucose
4. IV KCl as infusion
Select the correct answer using the code given below:
Acute Adrenal Crisis Interventions Explained
The patient presents with symptoms indicative of acute adrenal crisis, a life-threatening condition requiring prompt management. The appropriate interventions focus on fluid resuscitation, glucocorticoid replacement, and management of potential metabolic disturbances.
Assessment of Interventions
- 1. IV normal saline: This is crucial for fluid resuscitation. Patients with adrenal crisis often experience significant volume depletion due to vomiting, diarrhoea, and reduced intake, leading to circulatory shock. Normal saline helps restore intravascular volume and blood pressure.
- 2. IV hydrocortisone 100 mg stat: Glucocorticoid deficiency is the hallmark of adrenal crisis. Immediate administration of stress-dose hydrocortisone (e.g., 100 mg IV bolus) is essential to replace cortisol, improve vascular tone, and manage shock.
- 3. IV 10% glucose: Adrenal insufficiency impairs gluconeogenesis and can lead to hypoglycemia, especially during stress. Intravenous glucose administration is necessary to prevent or correct low blood sugar levels.
- 4. IV KCl as infusion: While adrenal insufficiency can sometimes cause hyperkalemia (due to aldosterone deficiency), hypokalemia is less common. Aggressive fluid resuscitation and hydrocortisone administration can influence potassium levels. IV KCl is not a standard initial intervention unless specific evidence of significant hypokalemia is present and requires correction. Hyperkalemia is more commonly associated with untreated Addison's disease, but acute crisis management prioritizes fluids, steroids, and glucose.
Conclusion
Based on the immediate needs in an acute adrenal crisis presenting with shock, nausea, vomiting, and diarrhoea, the appropriate initial interventions are fluid replacement (IV normal saline), glucocorticoid therapy (IV hydrocortisone), and management of potential hypoglycemia (IV 10% glucose).
Therefore, interventions 1, 2, and 3 are appropriate.
Important Questions from Adrenal Disorders
- Which one of the following is a cause of Secondary Hyperaldosteronism?
Which of the following are correct regarding Cortisol?
1. Levels are highest in the morning on waking.
2. Cortisol falls dramatically during an illness.
3. More than 95% circulating cortisol is protein bound.
4. It is the major glucocorticoid in humans and can also activate mineralocorticoid receptors.
Select the answer using the code given below :
- A 50-year lady, who is a known case of rheumatoid arthritis, presents with obesity, moon facies, abdominal striae and hypertension. Overnight dexamethasone suppression test shows serum cortisol is greater than 50 nmol/L, serum ACTH is less than 1.1 pmol/L. The adrenal imaging and brain CT/MRI imaging studies are unremarkable. The likely diagnosis is
- Hirsutism is seen in which of the following ?
1. Polycystic ovarian syndrome
2. Congenital adrenal hyperplasia
3. Hypothyroidism
4. Ovarian tumour
Select the correct answer using the code given below: - Escape behaviour with paroxysmal occurrence is seen in:
