Adrenal Crisis

Masquerade

Step 1: View clinicals

A 15 year old boy presents with severe vomiting and diarrhea for 1 day and confusion since waking up today. He complained of a fever and sore throat in the 5 days preceding this. His appetite has been poor for the last few months and he has lost some weight. His medical history is unremarkable.


Step 2: Order all relevant investigations

Full Blood Count

WBC/DC: 14,000/mm3 N: 70% L: 25% Hb: 16 g/dL Hct: 50% Platelets: 250,000/mm3

Arterial Blood Gases

PO2: 90 mmHg (normal: > 75) PCO2: 30 mmHg (normal: 35 - 45) Ph: 7.35 (normal: 7.35 - 7.45) HCO3-: 18 (normal 22 - 26)

Renal profile

Urea: 60 mg/dL (normal: 0 - 50) S. Creatinine: 1.6 mg/dL (normal: 0.5 - 1.5) Na+ 127 mEq/L (normal: 135 - 145) K+ 4.0 mEq/L (normal: 3.5 - 5.5) Cl- 99 mEq/L (normal: 95 - 110)

Random Cortisol

6 microg/dL (normal: 5 - 15)


Step 3: Select appropriate management

IV Antibiotics
IV 1.8% saline
IV Hydrocortisone stat
Urgent Hemodialysis


Score: ★★☆