This handout is for adrenal crisis. Your care team identified this based on: refractory hypotension / shock (bornstein jcem 2016 ese).
Other reasons your team may use this plan: hyponatremia + hyperkalemia constellation (bornstein jcem 2016 ese; rushworth endocr rev 2019); unexplained hypoglycemia (bornstein jcem 2016 ese); altered mental status with shock (hahner jcem 2015).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| hydrocortisone | Adult: 100 mg IV/IM bolus STAT, then 50 mg IV q6h OR 200 mg/24h continuous infusion. Pediatric: <1y 25 mg, 1–5y 50 mg, ≥6y 100 mg IV/IM bolus, then 100 mg/m²/day infusion (or 25–50 mg q6h) | IV | q6h or continuous infusion | Endocrine Society 2016 + UK SfE 2020 — replaces cortisol AND mineralocorticoid effect at high dose; single most important intervention; mortality if delayed |
| dexamethasone | Adult 4 mg IV bolus (only if hydrocortisone unavailable AND ACTH stim test pending) | IV | single dose | Does not cross-react with cortisol assay; bridge until hydrocortisone arrives; lacks mineralocorticoid effect (Bornstein JCEM 2016 ESE) |
Plan: Adrenal crisis acute — stress-dose hydrocortisone + fluids + treat trigger (Bornstein JCEM 2016 ESE)
Call 911 or go to the nearest emergency room right away if you have:
Endocrine within 1 week; sick-day rules education; emergency hydrocortisone IM kit; medical alert ID; etiology workup completion; family screening if autoimmune (Bornstein JCEM 2016 ESE; Hahner JCEM 2015; NICE 2018 AI)
Guideline: 2016 Endocrine Society AI Guideline (Bornstein JCEM 2016) + NICE 2018 Adrenal Insufficiency + Rushworth Endocr Rev 2019 + Hahner JCEM 2015 + 2020 UK Society for Endocrinology Emergency Guidance