In adrenal crisis, which treatment should be administered immediately?

• A. Hydrocortisone
• B. Vasopressors
• C. 5% dextrose in NS (immediately)
• D. Insulin infusion

Answer: (C)

Adrenal crisis presents with severe volume depletion and shock from acute cortisol deficiency, so the immediate priority is to restore perfusion with IV fluids. The fastest way to do that is rapid administration of isotonic saline (0.9% NaCl), which expands intravascular volume, improves blood pressure, and helps correct hyponatremia caused by cortisol deficiency. Once IV access is established and fluids are begun, add stress-dose corticosteroid replacement (typically hydrocortisone 100 mg IV now, then 50 mg every 6 hours or via infusion) to address the cortisol shortage and support vascular tone. Dextrose-containing fluids are used if the patient is hypoglycemic or cannot maintain blood glucose, but they are not the first fluid choice because they don’t correct volume status as effectively and can complicate electrolyte management. Vasopressors may be needed if shock persists after adequate fluids and steroids, and insulin is not part of the initial adrenal crisis treatment unless there’s another separate indication for it.