How should I manage an acute adrenal crisis in a patient with known Addison's disease?

In the event of an acute adrenal crisis in a patient with known Addison's disease, immediately administer intravenous or intramuscular hydrocortisone, as there is no risk of overdose in an emergency situation, and the intramuscular dose can be given by anyone, including self-administration using an emergency management kit ¹.

Advise the patient to go to hospital in an ambulance without delay ¹.

Give 1 litre of 0.9% sodium chloride intravenous infusion over 30 minutes to the patient ¹.

Ensure frequent monitoring of blood pressure, heart rate, electrolyte, and glucose status during the crisis ¹.

Continue hydrocortisone infusion over 24 hours or intramuscular/intravenous injections (4 times daily) until the patient is haemodynamically stable and able to take oral glucocorticoids ¹.

Maintain intravenous infusion of 0.9% sodium chloride until haemodynamic stability is achieved ¹.

Once stable, offer at least 40 mg oral hydrocortisone daily in 2-4 divided doses or at least 10 mg oral prednisolone daily until the underlying cause is resolved and the patient is clinically stable ¹.

Identify and treat any underlying cause of the crisis ¹.