What is the treatment protocol for a patient in an Addisonian crisis?

In an Addisonian crisis, which is a severe and acute adrenal insufficiency, the primary treatment involves the immediate administration of intravenous hydrocortisone and intravenous fluids. This approach is critical because it addresses both the glucocorticoid deficiency and corrects any electrolyte imbalances, as well as rehydrating the patient.

The use of intravenous hydrocortisone quickly restores cortisol levels, helping to mitigate symptoms such as hypotension, shock, and severe fatigue commonly seen in an Addisonian crisis. Alongside hydrocortisone, IV fluids (often saline) are administered to help with volume repletion, particularly if the patient is experiencing significant hypotension or dehydration.

In contrast, other treatment options listed would not provide the rapid and effective management required in this life-threatening situation. Oral medications cannot be absorbed quickly enough to aid in an acute crisis, and high-dose steroids or hypertonic saline, while used in certain contexts, are not the standard treatment protocol for an Addisonian crisis. Subcutaneous epinephrine is unrelated to the management of adrenal insufficiency and is not indicated in this scenario. Thus, the administration of IV hydrocortisone and IV fluids constitutes the cornerstone of treatment for a patient experiencing an Addisonian crisis.