What is the initial fluid resuscitation choice in suspected acute adrenal crisis?

What is the initial fluid resuscitation choice in suspected acute adrenal crisis?

• A. Start rapid infusion of normal saline
• B. Administer dextrose 5% in water
• C. Administer a diuretic
• D. Administer saline plus potassium replacement

Answer: (A)

When acute adrenal crisis is suspected, the first priority is to restore circulating volume to improve tissue perfusion. The best initial move is a rapid infusion of normal saline. Isotonic saline quickly expands intravascular volume, raises blood pressure, and helps correct the hyponatremia that often accompanies adrenal insufficiency, without causing dangerous shifts in osmolality or electrolyte balance. Dextrose-containing fluids are reserved for treating hypoglycemia or for use after perfusion has been established; they do not by themselves restore volume. A diuretic would worsen dehydration and is not appropriate in this setting. Potassium replacement depends on lab results and is addressed after fluids and stabilization, since adrenal crisis can involve potassium disturbances that require careful management. Alongside fluids, prompt adrenal replacement with hydrocortisone is also essential to treat the underlying deficiency.

When acute adrenal crisis is suspected, the first priority is to restore circulating volume to improve tissue perfusion. The best initial move is a rapid infusion of normal saline. Isotonic saline quickly expands intravascular volume, raises blood pressure, and helps correct the hyponatremia that often accompanies adrenal insufficiency, without causing dangerous shifts in osmolality or electrolyte balance.

Dextrose-containing fluids are reserved for treating hypoglycemia or for use after perfusion has been established; they do not by themselves restore volume. A diuretic would worsen dehydration and is not appropriate in this setting. Potassium replacement depends on lab results and is addressed after fluids and stabilization, since adrenal crisis can involve potassium disturbances that require careful management. Alongside fluids, prompt adrenal replacement with hydrocortisone is also essential to treat the underlying deficiency.