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 NICE NG243.
Advise the patient to go to hospital in an ambulance without delay NICE NG243.
Give 1 litre of 0.9% sodium chloride intravenous infusion over 30 minutes to the patient NICE NG243.
Ensure frequent monitoring of blood pressure, heart rate, electrolyte, and glucose status during the crisis NICE NG243.
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 NICE NG243.
Maintain intravenous infusion of 0.9% sodium chloride until haemodynamic stability is achieved NICE NG243.
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 NICE NG243.
Identify and treat any underlying cause of the crisis NICE NG243.