ENDOCRINE

ResponseStem =Refractory shock unresponsive to fluid resuscitation
Adrenal crisis = Adisonian crisis = Cortisol insufficiency

ResponseStem - shocked patient with long term steroid use
NAGMA, hypoglycaemia, hyponatraemia, refractory shock

ResponseCorrect hypoglycaemia - 50% 50mL
IV steroids (hydrocort 100 or dex 8mg IV)
Address hypotension

• IV fluids up to 2L
• Norad for map >65

Seek and treat cause - likely sepsis - Broad spectrum ABx (? Fluclox + Gent)

ResponseEnsure patient has a “sick day plan” - typically doubling or tripling baseline steroid dosing

ResponseSmall bowel neuroendocrine tumours
Gastric/lung neuroendocrine tumours

ResponseOctreotide IV