一名有腎上腺功能不全病史的病患因急性呼吸道感染入院。其血壓為 88/50 mmHg，心跳 112 次/分。護理師應預期首先給予哪種藥物？
A client with a history of adrenal insufficiency is admitted for an acute respiratory infection. The client's blood pressure is 88/50 mmHg and heart rate is 112 bpm. Which medication should the nurse anticipate administering first?
- AIntravenous hydrocortisone✓ 正解靜脈注射氫化可的松
- BOral fludrocortisone口服氟氫可的松
- CInhaled albuterol吸入型沙丁胺醇
- DRegular insulin and 50% dextrose普通胰島素與50%葡萄糖
此病患正處於腎上腺危象（Addisonian Crisis）。生理壓力（如感染）會耗盡病人體內微量的皮質醇，導致嚴重的血管舒縮功能衰竭（低血壓）和休克。靜脈注射氫化可的松（Hydrocortisone）是救命的首選藥物，因為它能立即補充糖皮質激素，恢復血管對兒茶酚胺的反應，進而提升血壓。選項 D 用於治療高血鉀，雖然危象中可能伴隨高血鉀，但血流動力學的穩定是首要任務。選項 B 是口服藥物，在急性休克狀態下吸收不可靠。選項 C 針對呼吸症狀，但循環衰竭是目前的致命威脅。
This client is in adrenal (Addisonian) crisis. Physiologic stress such as infection depletes the body's limited cortisol reserves, resulting in severe vasomotor collapse (hypotension) and shock. IV hydrocortisone is the life-saving first-line drug because it immediately replaces glucocorticoid, restoring vascular responsiveness to catecholamines and raising blood pressure. Insulin/dextrose (D) treats hyperkalemia; while hyperkalemia may be present, hemodynamic stabilization is the priority. Oral fludrocortisone (B) is unreliable in shock. Albuterol (C) targets the respiratory symptom, not the circulatory failure that is currently most life-threatening.
美國醫院對於 Addisonian Crisis 的處理有標準化的 Stress-dose steroid 流程；台灣臨床護理師在發現此類病人血壓下降時，需高度警覺類固醇補給，並迅速準備 IV 推注，而非僅是一般補液。