Recognize
Consider chronic steroid exposure/withdrawal, known adrenal/pituitary disease, autoimmune disease, surgery/illness, hyponatremia, hyperkalemia or hypoglycemia.
endocrine / metabolic
Suspected Adrenal Crisis in Shock
Refractory hypotension with adrenal-risk history, electrolyte disturbance or hypoglycemia.
Act now
Draw cortisol/ACTH if this causes no delay; give hydrocortisone 100 mg IV/IM plus isotonic fluid and dextrose when needed.
Reassess
If shock persists, continue vasopressors and actively reassess sepsis, hemorrhage, cardiogenic and obstructive causes.
Evidence status
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Actionable Clinical Workflows (15)
Step-by-step ICU ProcessesInitial Hemodynamic Resuscitation & Shock Bundling
From recognizing hypoperfusion and initial crystalloid bolus to dynamic fluid responsiveness assessment and vasopressor targets.
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Vasopressor & Inotrope Initiation & TitrationFrom first-line norepinephrine titration to multi-agent vasopressor escalation and inotrope selection.
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Refractory Shock Support EscalationFrom multi-vasopressor failure to rescue non-adrenergic agents and mechanical circulatory support.
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HypotensionFrom confirming true hypotension to recognizing shock and its likely category.
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Deep-Dive Topic Destinations (2)
Reference KnowledgeAdrenal Crisisendocrine-metabolic
Time-critical recognition and empiric treatment of acute cortisol deficiency causing shock, electrolyte disturbance and hypoglycemia.
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Shock: Foundational Critical Care Frameworkcardiovascular
Cellular dysoxia, DO2/VO2 physiology, the 4 shock phenotypes, dynamic fluid responsiveness (PLR/PPV) vs fluid tolerance (VExUS), and vasoactive pharmacology.
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