Adrenal crisis
Paediatric emergency management · Endocrine · Emergency
Suspect in known adrenal insufficiency or CAH, or in shock unresponsive to fluids and pressors with hypoglycaemia, hyponatraemia and hyperkalaemia. Draw cortisol and glucose but do not delay steroids.
Immediate
- Use 0.9% saline (not hypotonic fluid); correct hyponatraemia slowly.
- Treat hyperkalaemia if there are ECG changes.
- Find and treat the precipitant — usually infection.
Common questions
What is the first step in adrenal crisis?
Suspect in known adrenal insufficiency or CAH, or in shock unresponsive to fluids and pressors with hypoglycaemia, hyponatraemia and hyperkalaemia. Draw cortisol and glucose but do not delay steroids.
What drug doses are used in adrenal crisis?
Hydrocortisone IV/IM: About 2 mg/kg (infant 25 mg, child 50 mg, adolescent 100 mg) bolus, then the same dose every 6 h or as an infusion. Dextrose (hypoglycaemia): 2 mL/kg of 10% dextrose IV (0.2 g/kg). Fluid bolus: 10–20 mL/kg of 0.9% saline, repeat as needed.
About this page
Compiled from standard paediatric references. Verify against a current formulary and your local protocol.
Spotted something wrong? Report an error on this page — corrections from clinicians are welcome and are reviewed before any change is published.
Last reviewed 2026-08-12.