What is the primary goal of therapy in an Addisonian crisis?

• A. Restore fluid and mineral balance and replace steroids.
• B. Treat hyperglycemia.
• C. Reduce potassium.
• D. Treat infection.

Answer: (A)

In an Addisonian crisis, the most urgent goal is to stabilize the patient by restoring fluid volume and electrolyte balance while providing steroid replacement. The rapid, isotonic fluid resuscitation corrects dehydration and hypotension, and helps address hyponatremia. Administering a glucocorticoid such as hydrocortisone gives immediate cortisol replacement and also provides some mineralocorticoid effect, which helps with sodium retention and potassium balance. If blood glucose is low, give dextrose-containing fluids as needed. After the patient is stabilized, continue steroid therapy and start long-term management with an appropriate mineralocorticoid replacement (like fludrocortisone) as needed. Treating an infection or other precipitating cause is important, but the primary, life-saving steps are fluids and steroids.