What is the emergency department treatment of adrenal crisis?

Updated: Oct 11, 2018
  • Author: Kevin M Klauer, DO, EJD, FACEP; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Emergency department care includes the following:

  • Maintain airway, breathing, and circulation in patients with adrenal crisis.

  • Use coma protocol (ie, glucose, thiamine, naloxone).

  • Use aggressive volume replacement therapy (dextrose 5% in normal saline solution [D5NS]).

  • Correct electrolyte abnormalities as follows:

  • Use dextrose 50% as needed for hypoglycemia.

  • Administer hydrocortisone 100 mg intravenously (IV) every 6 hours. During adrenocorticotropic hormone (ACTH) stimulation testing, dexamethasone (4 mg IV) can be used instead of hydrocortisone to avoid interference with testing of cortisol levels.

  • Administer fludrocortisone acetate (mineralocorticoid) 0.1 mg every day as needed. Mineralocorticoid administration is usually not necessary for treatment of secondary adrenocortical insufficiency.

  • Once the patient stabilizes, usually by the second day, the corticosteroid dose may be reduced and then tapered. Oral maintenance can usually be achieved by the fourth or fifth day.

  • Always treat the underlying problem that precipitated the crisis. Infectious etiologies commonly precipitate adrenal crisis. Recognition and treatment of causative factors are crucial aspects of managing adrenal hypofunction.


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