Begin treatment immediately in any suspected case (prognosis related to rapidity of treatment)
Treat underlying cause, if known
IVF - D5NS 2-3L (corrects fluid deficit and hypoglycemia)
Steroids
Hydrocortisone - 2mg/kg up to 100mg IV bolus
Drug of choice if K+>6 (provides glucocorticoid and mineralocorticoid effects)
Dexamethasone - 4mg IV bolus
Consider in hemodynamically stable patients if ACTH stimulation test will be performed (will not interfere with the test)
Along with methylprednisolone, dexamethasone has negligible mineralocorticoid effect, so choose hydrocortisone in:
Hypotension
Hyponatremia or hyperkalemia
Comparable steroid dosages
Hydrocortisone (50-75mg/m2 or 1-2mg/kg)
Methylprednisolone are 10-15mg/m2
Dexamethasone 1-1.5mg/m2
Vasopressors
Administer after steroid therapy in patients unresponsive to fluid resuscitation
Hydrocortisone - 2mg/kg up to 100mg IV bolus
Drug of choice if K+>6 (provides glucocorticoid and mineralocorticoid effects)
Dexamethasone - 4mg IV bolus
Consider in hemodynamically stable patients if ACTH stimulation test will be performed (will not interfere with the test)
Along with methylprednisolone, dexamethasone has negligible mineralocorticoid effect, so choose hydrocortisone in:
Hypotension
Hyponatremia or hyperkalemia
Comparable steroid dosages
Hydrocortisone (50-75mg/m2 or 1-2mg/kg)
Methylprednisolone are 10-15mg/m2
Dexamethasone 1-1.5mg/m2
Drug of choice if K+>6 (provides glucocorticoid and mineralocorticoid effects)
Consider in hemodynamically stable patients if ACTH stimulation test will be performed (will not interfere with the test)
Along with methylprednisolone, dexamethasone has negligible mineralocorticoid effect, so choose hydrocortisone in:
Hypotension
Hyponatremia or hyperkalemia
Hypotension
Hyponatremia or hyperkalemia
Hydrocortisone (50-75mg/m2 or 1-2mg/kg)
Methylprednisolone are 10-15mg/m2
Dexamethasone 1-1.5mg/m2
Administer after steroid therapy in patients unresponsive to fluid resuscitation
To aid in mounting stress response in those with<unk>  insufficiency lacking endogenous cortisol
Adrenal crisis
Cardiogenic
Diabetic ketoacidosis 
Acute valvular Regurgitation/VSD
Diabetic ketoacidosis
CHF
Thyroid storm
Dysrhythmia