Medical Emergencies · patient case question
What is the best management for this patient?
Patient case: Case: lethargy, low blood pressure and bronze skin
Scenario: A female patient is markedly lethargic. Her blood pressure is 80/60 and her skin shows a diffuse bronze pigmentation.
Show answer and explanation
Correct answer: D. Refer to a physician for diagnosis and medical management
- A. Fludrocortisone is a mineralocorticoid used in confirmed adrenal insufficiency, again a physician's prescription after diagnosis.
- B. Steroid replacement is a physician's decision requiring biochemical confirmation and titration. Starting steroids blindly can mask the diagnosis and cause harm.
- C. Proceeding with elective treatment in an unstabilised patient risks precipitating an adrenal crisis — hypotension, collapse and shock.
- D. Correct. This is an undiagnosed systemic endocrine disorder. It needs medical workup and stabilisation before any elective dental care; the dentist's role is timely referral.
Note: Once diagnosed and stabilised, the concern shifts to adrenal crisis under stress. Discuss any need for supplemental steroid cover with the physician rather than assuming it.
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