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J R Soc Med 1989;82:741-742
© 1989 Royal Society of Medicine

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Journal of the Royal Society of Medicine, Vol 82, Issue 12 741-742, Copyright © 1989 by Royal Society of Medicine

ORIGINAL ARTICLES

Pitfalls in the management of acute adrenocortical insufficiency: discussion paper

A Waise and RJ Young
Department of Clinical Biochemistry, Hope Hospital, University of Manchester School of Medicine, Salford.

In patients with acute adrenocortical insufficiency prompt recognition and treatment may be life-saving. Treatment should be initiated immediately before confirmation of the diagnosis. As shown by these case reports, junior staff on acute medical and surgical services, to whom these patients usually first present, may not appreciate that (a) hyponatraemia and hyperkalaemia, in the absence of renal failure, should immediately suggest the diagnosis of adrenal insufficiency and (b) treatment should precede confirmation of the diagnosis. Attempts to correct hyperkalaemia due to adrenocortical insufficiency with insulin and infusions of dextrose is inappropriate and potentially dangerous but seems to be a not unusual mistake.
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