Adrenal crisis are rare, but can occur in the context of classic CAH - when the patient is ill, severely injured or post surgery

PC

• Vomitting
• Abdominal pain
• Fever
• Altered mental status (confusion-coma)
• Hypotension or shock

Investigations

• Hypoglycaemia
• Electrolyte imbalances
  • Hyponatraemia
  • Hyperkalaemia

Management

• IV bolus of 5% dextrose diluted in 0.9% saline
  • Dose - 20mL/kg, over 1 hour
• +IV bolus of Hydrocortisone
  • <3 yrs - 25mg
  • 3-12 yrs - 50mg

  • 12 yrs - 100mg

• Hyperkalaemia should improve rapidly after hydrocortisone infusion - if it persists glucose and insulin can be given