Wed3November0919PM 15

A 16-year-old girl is brought to the Emergency department by her parents.

She has a two day history of general malaise, vomiting and vague abdominal discomfort. Over the past twelve hours she has become increasingly drowsy.

On examination she was unresponsive to verbal commands. Her temperature 36.5°C, BP 74/48 mmHg.

Investigations revealed:

Sodium 121 mmol/L (137-144)

Potassium 6.2 mmol/L (3.5-4.9)

Urea 11.6 mmol/L (2.5-7.5)

Creatinine 162 µmol/L (60-110)

Glucose 1.1 mmol/L (3.0-6.0)

Chloride 91 mmol/L (95-107)

Bicarbonate 14 mmol/L (20-28)

After giving emergency treatment, what single investigation would be of most value in confirming the diagnosis?

(Please select 1 option)

Fasting blood glucose

CT scan abdomen Incorrect answer selected

Autoantibody screen

Insulin + C peptide levels

Tetracosactrin (Synacthen) test This is the correct answer

Explanation

The patient has presented with an Addisonian crisis.

A definitive diagnosis is made with a Synacthen test.

Answer Statistics

1

2%

2

9%

3

4%

4

11%

5

76%

Times answered: 275