What is the emergency department treatment of adrenal crisis?

Updated: Sep 01, 2020
  • Author: Kevin M Klauer, DO, EJD, FACEP; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
  • Print

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.

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!