DOC in adrenal insufficiency -
Ans. is 'c' i.e., Dexamethasone Treatment of acute adrenal insufficiency (adrenal crisis) in adultsEmergency measuresEstablish intravenous access with a large-gauge needle.Draw blood for immediate serum electrolytes and glucose and routine measurement ofplasma cortisol and A CTH. Do not wait for lab results.Infuse 2 to 3 liters of isotonic saline or 5 precent dextrose in isotonic saline as quickly as possible. Frequent hemodynamic monitoring and measurement of serum electrolytes should be performed to avoid iatrogenic fluid overload.Give 4 mg dexamethasone as intravenous bolus over one to five minutes and every 12 hours thereafter Dexamethasone is the drug of choice because it does not interfere with the measurement ofplasma cortisol. If dexamethasone is unavailable, intravenous hydrocortisone, 100 mg immediately and every six hours thereafter, may be used.Use supportive measures as needed.Subacute measures after stabilization of the patientContinue intravenous isotonic saline at a slower rate for next 24 to 48 hours.Search for and treat possible in fections precipitating causes of the adrenal crisis.Perform short ACTH stimulation test to confirm the diagnosis of adrenal insufficiency, ifpatient does not have know adrenal insufficiency. Determine the type of adrenal insu fficiency and its cause if not already known.Taper parenteral glucocorticoid over one to three days, if precipitating or complicating illness permits, to oral glucocorticoid maintenance dose.Begin meneralocorticoid replacement with fludrocortisone, 0.1 mg by mouth daily, when saline infusion is stopped.
Norepinephrine
Adrenaline
Dexamethasone
Fludrocortisone
Adrenal