Woman with altered mental status, weakness, abdominal pain- Let’s Diagnose

A 70-year-old woman arrived at the ED by ambulance with an altered mental status and hypotension. She complained of abdominal pain and nausea. Her doctor noted she seemed weak and lethargic. When her husband arrived, he was able to explain that she had been on a high dose of corticosteroid for many years for a chronic condition, but due to his own recent health setback, neither of them had been able to get to the pharmacy to fill the prescription for the past two weeks. He reported his wife had no recent injuries or surgeries.

Is it Addison disease, diabetic ketoacidosis, adrenal crisis, or bacterial sepsis?

Check out our differential on VisualDx.

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