In Addisonian crisis, which fluid is indicated for replacement?

• A. Potassium chloride
• B. Normal saline solution
• C. Hypertonic saline
• D. Lactated Ringer's solution

Answer: (B)

In Addisonian crisis, the top priority is to restore intravascular volume and correct shock from severe dehydration and electrolyte disturbances. The fluid of choice for this rapid replacement is isotonic normal saline. It delivers sodium and chloride to help reverse hyponatremia and expand the circulating volume without introducing excess potassium or other shifts that could worsen the patient's condition. Potassium chloride would worsen hyperkalemia, which is common in adrenal insufficiency due to aldosterone deficiency. Hypertonic saline is not the standard initial choice for volume depletion unless there’s severe, symptomatic hyponatremia with brain involvement. Lactated Ringer’s contains potassium and lactate, which can complicate hyperkalemia and is not preferred as the first-line fluid in this crisis. After stabilization with normal saline, corticosteroid replacement and careful electrolyte management are implemented.