A 21-year-old woman is brought to the emergency department because of a 1-day history of acute abdominal pain and vomiting. She also has a 2-day history of fever, headache, and neck pain. She is confused and oriented only to place and person. Her temperature is 39.7°C (103.5°F), pulse is 148/min, blood pressure is 90/50 mm Hg, and respiratory rate is 28/min. Generalized hyperpigmentation is present and is most conspicuous over the face, neck, and dorsal surface of the hands. Urinalysis and chest x-ray are within normal limits. Finger-stick blood glucose is 60 mg/dL. A 1-L bolus of normal saline is rapidly infused, and high-flow intravenous fluids are continued. This patient also requires immediate treatment with which of the following medications?

Question

A 21-year-old woman is brought to the emergency department because of a 1-day history of acute abdominal pain and vomiting. She also has a 2-day history of fever, headache, and neck pain. She is confused and oriented only to place and person. Her temperature is 39.7°C (103.5°F), pulse is 148/min, blood pressure is 90/50 mm Hg, and respiratory rate is 28/min. Generalized hyperpigmentation is present and is most conspicuous over the face, neck, and dorsal surface of the hands.  Urinalysis and chest x-ray are within normal limits.  Finger-stick blood glucose is 60 mg/dL.  A 1-L bolus of normal saline is rapidly infused, and high-flow intravenous fluids are continued.  This patient also requires immediate treatment with which of the following medications?

Quizplus · Accepted Answer

Eductional Objective: Patients with adrenal insufficiency are not able to increase glucocorticoid production in response to acute stress (eg, illness, surgery).  Adrenal crisis is characterized by severe hypotension, abdominal pain, vomiting, weakness, and fever.  In addition to aggressive fluid resuscitation, treatment requires immediate glucocorticoid supplementation.

A 21-Year-Old Woman Is Brought to the Emergency Department Because