Theme: Endocrine
Key words: Adrenal insufficiency, Addison’s disease, shock, steroid replacement
A 32-year-old female presents to the emergency department with reduced conscious level and a 1-day history of vomiting, diarrhoea and abdominal pain. Her observations are as follows:
SpO2 100% on 15L O2 NRB
RR 24
HR 118
BP 62/28
T 38.1
On examination, she is GCS 8 (E2, V2, M4). She has a low BMI and despite being cold and clammy, appears tanned. Blood glucose is 3.8
Resuscitation is started with I0 fluids before IV access is obtained. 2L of crystalloid is infused with little change to her observations. Her BP does not improve with vasopressors. She is started on an IV glucose infusion which normalises her blood glucose, however her GCS does not improve. She is intubated and admitted to ICU.
