رجل عمره ٤١ سنة يأخذ بريدنيزولون ٢٠ ملغ يومياً منذ ٦ أشهر لمرض مناعي، وأوقفه فجأة قبل ٤ أيام. جاء بتعب شديد ودوخة وقيء وألم بطن. الضغط ٧٨/٤٦، والنبض ١٢٢، والصوديوم ١٢٨، والبوتاسيوم ٥٫٦، والسكر ٦٢. ما الحالة الأرجح والعلاج الأول؟

A 41-year-old man has taken prednisolone 20 mg daily for 6 months for an autoimmune condition and stopped it abruptly 4 days ago. He presents with severe fatigue, dizziness, vomiting and abdominal pain. BP 78/46, HR 122, sodium 128, potassium 5.6, glucose 62. What is the condition and first treatment?

1. A diabetic episode needing IV insulin
2. Simple gastritis needing an oral antiemetic only
3. Mild dehydration needing oral rehydration only
4. Adrenal crisis, treated with IV hydrocortisone and fluids

Answer: D) Adrenal crisis, treated with IV hydrocortisone and fluids. Abrupt withdrawal after long-term steroids causes acute adrenal insufficiency: hypotension, hyponatraemia, hypoglycaemia and hyperkalaemia. Give IV hydrocortisone immediately with fluids and glucose.