A woman collapses with hypotension and hyponatraemia, hyperkalaemia and hypoglycaemia. She has pigmentation of her palmar creases. What is the immediate treatment?

Answer and explanation

Correct answer: C. Intravenous hydrocortisone 100 mg and IV fluids

  1. Step 1: This is Addisonian crisis.
  2. Step 2: Hydrocortisone and saline are life saving.
Answer
Intravenous hydrocortisone 100 mg and IV fluids.
Why not the others: Restrict fluids to avoid worsening the hyponatraemia, and give glucagon: Fluid restriction worsens shock. Oral fludrocortisone alone, with fluids restricted until the potassium has fallen: Fludrocortisone alone is insufficient. Levothyroxine 100 micrograms, to treat presumed myxoedema: Levothyroxine alone is dangerous in adrenal insufficiency.

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