# 原發性腎上腺功能不全病人因噁心停prednisone 3天後出現嘔吐、低血壓84/52、血糖58、Na 128、K 5.8。最立即優先處置?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375012&lang=zh-tw  
> language: zh-TW  
> subject: NCLEX-RN  
> category: PA

## 題目

原發性腎上腺功能不全病人因噁心停prednisone 3天後出現嘔吐、低血壓84/52、血糖58、Na 128、K 5.8。最立即優先處置?

## 選項

1. 立即給予IV hydrocortisone 100 mg為最優先 **✔ 正確答案**
2. 對血糖58 mg/dL啟動IV insulin滴注
3. 因脫水積極補K
4. 等待cortisol結果再給類固醇

**正確答案: 1**

## 解析

腎上腺危象為威脅生命急症。IV hydrocortisone 100 mg bolus立即給予,不等檢驗。續以等張食鹽水加葡萄糖補容量與低血糖。Insulin會加重低血糖(58)。K高(5.8)禁忌補K — 容量與類固醇能矯正K。可抽cortisol但治療絕不延遲。

## 深入解析

病日規則:發燒時口服類固醇加3倍;嘔吐或無法口服時改為IV壓力劑量。需配戴醫療警示。

## 臨床情境

嗜睡但可喚醒。HR 122、RR 24、體溫37.8°C。無心臟病史。

## 重要概念

- **腎上腺危象** — 腎上腺功能不全急性失代償 — 低血壓、低血糖。
- **壓力劑量類固醇** — 腎上腺功能不全於疾病、手術、外傷時加量glucocorticoid。
- **原發性腎上腺功能不全** — 腎上腺皮質衰竭(愛迪生病) — 皮質醇與醛固酮皆缺乏。

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