Addison’s Crisis or Momordica Charantia Extract: Which Caused Shock?

Abstract

Aim: Addison’s crisis is extremely rare entity that is difficult to diagnose in the emergency department. Here we present a case of Addison’s crisis diagnosed in the emergency department who complained of vomiting after consuming extract of Momordica charantia fruit for gastric pain.
 
 Case: A 29-year-old female was admitted to the emergency department with complaints of nausea and vomiting after consuming Momordica charantia extract for stomach pain. The patient had tachypnea, tachycardia, hypoglycemia, and hypotension. Blood tests revealed elevated anion gap (24 mEq/L) metabolic acidosis, +4 acetone, normokalemia, and hyponatremia. Although it was impossible to exclude intoxication immediately, 100 mg hydrocortisone was given IV due to possible Addison’s crisis after obtaining blood samples for hormone testing and excluding other causes of shock. The tests revealed very high ACTH (1.250 pg/mL) and low cortisol (1.23 ug/dL) levels, and the patient was diagnosed with primary adrenal insufficiency.
 
 Conclusion: This case illustrates the importance of comprehensive examination and management of profound hypotension and hypoglycemia in the emergency department and of emergency physicians diagnosing and initiating appropriate treatment for Addison’s crisis.