Fluids

A rapid infusion of 5% dextrose and isotonic saline should be started immediately. This acts to correct dehydration, hypotension, hyponatremia, and hypoglycemia. The extracellular volume deficit in the average adult in adrenal crisis is approximately 20 percent, or 3 L. The first liter should be given over 1 h, and 2 or 3 L may be required during the first 8 h of therapy. The functional capacity of the cardiovascular system is reduced with adrenal insufficiency, and the usual precautions with the rapid administration of saline should be observed.

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