Which set of findings would prompt the nurse to plan high-dose intravenous fluids and high-dose steroids for suspected Addison's crisis?

Which set of findings would prompt the nurse to plan high-dose intravenous fluids and high-dose steroids for suspected Addison's crisis?

• A. Blood pressure 120/80 mmHg, potassium 4.2 mEq/L, sodium 140 mEq, and confusion
• B. Blood pressure 98/56 mmHg, potassium 6.0 mEq/L, sodium 126 mEq, and confusion
• C. Blood pressure 110/70 mmHg, potassium 3.5 mEq/L, sodium 145 mEq, and alert
• D. Blood pressure 85/50 mmHg, potassium 4.5 mEq/L, sodium 132 mEq, and confusion

Answer: (B)

Addisonian crisis causes severe hypotension from volume depletion and deficits of cortisol and aldosterone, leading to hyponatremia and hyperkalemia with possible confusion from poor cerebral perfusion. When you see low blood pressure together with high potassium and low sodium, especially with mental status changes, it signals an endocrine emergency that requires rapid intervention. Administering high-dose intravenous fluids quickly restores intravascular volume and perfusion, while high-dose steroids replace deficient cortisol and provide some mineralocorticoid activity to help correct the electrolyte disturbances and support blood pressure. The pattern of findings described as low BP, hyperkalemia, hyponatremia, and confusion best fits Addisonian crisis and justifies this aggressive treatment approach. The other presentations lack this combination of hypotension with both hyponatremia and hyperkalemia, so they fit adrenal crisis less well.

Addisonian crisis causes severe hypotension from volume depletion and deficits of cortisol and aldosterone, leading to hyponatremia and hyperkalemia with possible confusion from poor cerebral perfusion. When you see low blood pressure together with high potassium and low sodium, especially with mental status changes, it signals an endocrine emergency that requires rapid intervention. Administering high-dose intravenous fluids quickly restores intravascular volume and perfusion, while high-dose steroids replace deficient cortisol and provide some mineralocorticoid activity to help correct the electrolyte disturbances and support blood pressure. The pattern of findings described as low BP, hyperkalemia, hyponatremia, and confusion best fits Addisonian crisis and justifies this aggressive treatment approach. The other presentations lack this combination of hypotension with both hyponatremia and hyperkalemia, so they fit adrenal crisis less well.