During an Addisonian crisis, which medication is contraindicated because it can worsen hyperkalemia?

• A. Potassium chloride
• B. Normal saline solution
• C. Hydrocortisone
• D. Fludrocortisone

Answer: (A)

In an Addisonian crisis, the body lacks both cortisol and aldosterone, leading to low blood pressure, volume depletion, and impaired potassium excretion (hyperkalemia). The priority is to restore perfusion and correct electrolyte disturbances without making hyperkalemia worse. Potassium chloride is contraindicated because it adds potassium to the system, raising serum potassium further and increasing the risk of life-threatening arrhythmias.

Why the other options fit: normal saline is used to expand intravascular volume and support perfusion, addressing shock and hyponatremia without adding potassium. Hydrocortisone is essential because it replaces cortisol and provides some mineralocorticoid effect, helping to stabilize hemodynamics and promote potassium excretion. Fludrocortisone is a mineralocorticoid used for ongoing management after stabilization to maintain sodium retention and potassium balance, rather than as an acute corrective measure.