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CPE-008 · Safety
AI-12: Possible adrenal crisis
Possible adrenal crisis. Evaluates systolic blood pressure below 90 mmHg or shock.
Active rulePriority 1Adrenal engine v1.0.0
Condition
- systolic blood pressure < 90 mmHg or shock
- with known adrenal insufficiency, chronic glucocorticoid use, hyponatremia, hyperkalemia, hypoglycemia, or vomiting/fever/trauma/surgery in an at-risk patient
What it reports
- Emergency: suspected adrenal crisis. Treat first per protocol; do not wait for test results. Draw cortisol and ACTH if it does not delay treatment
Never outputs
- a glucocorticoid dose
Diagnostic boundary
- The engine names no dose.
Evidence
- EV-ES-PAI-2016Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(2):364-389.Supports: Morning cortisol and ACTH as first tests; ACTH stimulation with 250 µg cosyntropin; peak cortisol below 18 µg/dL as insufficient Suspected adrenal crisis must be treated without waiting for tests
- EV-RUSHWORTH-2019Rushworth RL, Torpy DJ, Falhammar H. Adrenal Crisis. N Engl J Med. 2019;381(9):852-861.Supports: Recognition of adrenal crisis and its precipitants
Cases where this rule fires
Open a case to see this rule fire with real inputs, then change the values until it stops.
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