A 72-year-old woman presents to the emergency room with 1-day history of nausea and vomiting. She was recently discharged from hospital 3 weeks ago after a bronchial asthma exacerbation and has completed a glucocorticoid taper 1 week ago. Over the last year, she has had several hospital admissions due to bronchial asthma exacerbations. On examination, HR 120/min, BP 80/60 mmHg, RR 12/min, and O2 Saturation 94%. Her abdomen is diffusely tender but no peritoneal signs. Her investigations show glucose 70 mg/dL, sodium 125 mEq/L, potassium 3.9 mEq/L, and urine analysis shows 75 leukocytes/HPF. She is treated with 1L of normal saline and empiric broad- spectrum antibiotics. Which of the following is the most appropriate next step in treatment?
سؤال مجاني 2 من 10 اليوم · اشترك وكمّل بدون حد
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الإجابة والشرح
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الإجابة: B. Hydrocortisone IV bolus
Recent glucocorticoid taper after repeated steroid courses + an infection (UTI) as a stressor + hypotension, tachycardia, hyponatremia and borderline hypoglycemia = adrenal crisis (secondary AI from steroid withdrawal). After ABC and IV fluids, the next step is to replace glucocorticoids with IV hydrocortisone.
- Norepinephrine (D) will not correct the hypotension until cortisol is replaced.
- Glucose 70 mg/dL does not need a 50% dextrose bolus, and hypertonic saline (C) is not indicated for Na 125 without severe neurological symptoms.
- المصدر
- RT - Adrenal.pdf · p. 13
RT - Adrenal.pdf · p. 14 - المحاضرة
- Adrenal Crisis · Endocrinology · Module B
- ظهر في
- Endo bank