The other day, I had a real life experience that reminded me why people with adrenal insufficiency need an injection kit. Negligent doctors will not prescribe Solu-Cortef and the needles (in some states, prescriptions are needed for the needles). It is standard protocol and life saving to have an injection kit on hand at all times.
"The endocrinologist has a responsibility to ensure that Addison’s patients have adequate access to life-saving emergency injection materials and repeated, practical training sessions in how to use them,while the general practitioner plays a vital role as in arranging prompt emergency admissions." Adrenal crisis in treated Addison's Disease: a predictable but under-managed event, Katherine White and Wiebke ArltHere is what happened to me. I went to sleep on Thursday night after spending some of the day in preparation for the approaching hurricane. Not a big deal, I was not stressed about the hurricane nor the preparations. I awoke twenty minutes later and thought, "OH SHIT, I'M GOING TO THROW UP." I have not thrown up for four years, since I quit drinking. I knew this was serious. I immediately put an 8 mg Zofran ODT in my mouth and grabbed a throw up bowl. I threw up immediately. I knew it was not over. My husband got my injection kit and began studying the directions. In the mean time, I contacted a fellow adrenal insufficient person and then threw up a couple more times. Stupidly, I was uncertain as to whether I needed the injection or not. The answer was a resounding, "Yes!" I hate shots so I tried to put HC under my tongue but it didn't make me stop throwing up.
"...gastroenteritis is a particular dangerous cause of adrenal crisis, oral hydrocortisone is frequently insufficient to reverse impending adrenal crisis, current education of patients is often not sufficiently effective, unwillingness to call for help...carries a huge risk, and at a certain point in time damage from adrenal crisis will become irreversible no longer responding to medical measures." Adrenal Crisis, Bruno AllolioHere is where things went wrong:
1) My husband didn't know what to do and felt the need to do everything perfectly as opposed to quickly. He was VERY slow to give the shot
2) I was hesitant to receive a shot despite its lifesaving qualities
3) I had several Acto-Vials that were expired and/or battered. It took several tries to find a vial that would work properly
I was given the shot by my husband with coaching from the AI friend. Her advice, "Just stick her now!" I didn't feel better immediately but the vomiting did stop after about an hour.
This is the part I want you to read if you have adrenal insufficiency and don't have an injection kit.
Hurricane Matthew was to take a direct hit on Vero Beach, Florida 2:00 to 4:00 am. I began the vomitfest at about 11:00 pm. If I had not had an injection kit, there was no way in hell that my husband could have gotten me to the hospital nor was there any way for EMTs to come to my house. I could have died waiting for the opportunity for things to clear up enough and roads to be open.
If your doctor has put you in the position of dying by refusing to prescribe an injection kit, find a new doctor or find the White and Arlt study that I quoted above and take it to your doctor. Don't die just so your doctor can be "right" that you do not need an injection kit. You do need an injection kit. It could save your life.
An injection kit should include:
- 100 mL Solu-Cortef Acto-Vial
- 21 gauge needle
- 25 gauge needle (length will depend upon how much fat you have on your leg)
- Zofran ODT (I can't stress the ODT enough) ODT, ODT, ODT
- Alcohol pads
- NADF emergency crisis form
- Instructions on how to give the shot are vital. I like the NZ Addison's injection directions
- A few hydrocortisone pills and some salt pills