A patient with a history of adrenal insufficiency presents with severe fatigue and hypotension during an illness. What should be administered immediately?
- A) Hydrocortisone injection ✓
- B) Fludrocortisone tablet
- C) IV fluids only
- D) Glucose solution
When a patient with a history of adrenal insufficiency presents with severe fatigue and hypotension, it is crucial to address the potential adrenal crisis that may be occurring. Adrenal insufficiency can lead to inadequate production of cortisol, especially during times of stress such as illness or infection. The symptoms of adrenal crisis include severe fatigue, hypotension (low blood pressure), and other systemic manifestations.
Step 1: Recognizing the Condition
In patients with known adrenal insufficiency, the body’s ability to respond to stress is compromised due to insufficient cortisol levels. Cortisol plays a vital role in maintaining vascular tone, regulating metabolism, and managing the body’s response to stress. Therefore, when faced with an acute illness, these patients are at high risk for an adrenal crisis.
Step 2: Evaluating Treatment Options
Now let’s evaluate the treatment options provided:
- A) Hydrocortisone injection: This is a glucocorticoid medication that can rapidly replace deficient cortisol levels in patients experiencing an adrenal crisis. Administering hydrocortisone can help restore hemodynamic stability and alleviate symptoms associated with low cortisol levels.
- B) Fludrocortisone tablet: Fludrocortisone is a mineralocorticoid used primarily for its effects on sodium retention and potassium excretion. While it is important for long-term management of adrenal insufficiency, it does not provide immediate relief in acute situations.
- C) IV fluids only: While intravenous fluids can help manage hypotension by increasing blood volume, they do not address the underlying deficiency in cortisol that is critical in an adrenal crisis.
- D) Glucose solution: Administering glucose may be necessary if hypoglycemia is present; however, it does not treat the underlying cause related to adrenal insufficiency.
Step 3: Determining the Best Course of Action
Given the urgency of treating an adrenal crisis and considering that this patient exhibits signs consistent with such a condition (severe fatigue and hypotension), immediate administration of hydrocortisone injection is essential. It directly addresses the lack of cortisol and helps stabilize blood pressure effectively.
Therefore, based on this analysis:
The correct answer is: A) Hydrocortisone injection.
