A 23-year-old woman with type 1 diabetes mellitus and vitiligo is brought to the emergency department with vomiting, abdominal pain, fever, and confusion. She is hypotensive despite receiving 2 liters of intravenous fluids. Physical examination shows diffuse skin hyperpigmentation. Laboratory studies show sodium 122 mEq/L, potassium 6.1 mEq/L, glucose 48 mg/dL, and creatinine 1.8 mg/dL. Which of the following is the best next step in management?
- A)Oral fludrocortisone only
- B)Overnight low dose dexamethasone suppression test
- C)Thyroid hormone replacement before any other therapy
- D)Intravenous propranolol
- E)High dose intravenous hydrocortisone and aggressive intravenous fluidsGABARITO
Explicação
This patient has adrenal crisis from primary adrenal insufficiency. Adrenal crisis is life threatening and requires immediate stress dose intravenous glucocorticoids along with isotonic fluids. Ver explicação completa e trilha adaptativa →