"I've never had a crisis! I don't need to be prepared for a crisis."
NOT! Just cause you haven't been hit by a bus yet doesn't mean you won't. Being hit by a bus is a crisis, so is vomiting.
If you have Addison's, you DO need to be prepared for a crisis as does anyone around you.
You CAN die from an untreated crisis.
"But my doctor said I didn't need an injection kit!"
Your doctor is uninformed and doesn't understand Adrenal Insufficiency. Ambulances DO NOT CARRY SOLU-CORTEF and EMTs (Paramedics are) are NOT PERMITTED TO INJECT SOLU-CORTEF, even if you have your needle, alcohol pads and Actovial on your lifeless chest. Check with your local EMTs if you don't believe me.
"When I get to the ER, they will know what to do."
Hello! SO NOT true. If you've ever been to the ER and they've injected you with Medrol or Dexamethasone, they don't know what they are doing. Neither Dex nor Medrol are the best choice for an emergency because they take a long time to kick in and have little or no mineralocorticoid properties.
Besides, how long does it take to get checked into the ER and treated, even in the event of an emergency. It could be too long and you could die. Really. During a crisis, death is a possibly.
WHERE DO YOU START?
You start well before a crisis ever happens.
Order a medicalert.com bracelet.
You make an appointment with your doctor and request the following:
- Extra HC in your prescription for stress dosing and to keep stashes in your purse or wallet or whatever.
- Zofran or the generic 8 mg for nausea.
- 100 mg Solu-Cortef Actovial DO not accept anything different.
- Needle prescription (some states)
You increase your hydrocortisone if you vomit or have diarrhea.
You carry the
Addison's Emergency Protocol form IN YOUR WALLET WITH YOUR INSURANCE CARD. You also give the Emergency Protocol form to a significant other, parent, child whomever.
P 1189
Prevention and management of adrenal crisis
In a series of 53 patients with chronic adrenal
insufficiency, representing 511 replacement-years, we
noted an overall risk of adrenal crisis needing hospital
admission of 3·3 per 100 years. Risk of crisis was much
higher in primary adrenal insufficiency (3·8 per 100 vs
2·5 per 100 years) and in women (4·4 per 100 vs 1·6 per
100 years) with the highest overall risk in women with
autoimmune adrenalitis (6·5 per 100 years). Most crises
were due to glucocorticoid dose reduction or lack of
stress-related dose adjustment by patients or family
practitioners. Inappropriate stress-related glucocorticoid
adjustment occurs more often in patients older than age
60 years.
134
All patients and their partners should receive
regular crisis prevention training, including verification
of steroid emergency card or bracelet and instruction on
stress-related glucocorticoid dose adjustment. Patients
should add 5–10 mg hydrocortisone to their normal
regimen shortly before strenuous activities—eg, hiking.
More severe physical stress such as fever requires
doubling of daily doses until recovery. In instances of
vomiting or diarrhoea, glucocorticoids should be
administered parenterally. Some doctors advocate a
hydrocortisone emergency supply for rectal or parenteral
self-administration.
135,136
For major surgery, trauma,
and diseases that require monitoring in intensive care,
patients should receive intravenous infusions
of 100–150 mg hydrocortisone in 5% glucose per 24 h.
Results of some studies
137,138
advocate lower doses
(25–75 mg per 24 h) for minor or moderate surgical
stress.
Management of acute adrenal crisis consists of
immediate intravenous administration of 100 mg
hydrocortisone followed by 100–200 mg per 24 h and
continuous infusion of larger volumes of physiological
saline solution (initially 1 L/h) under continuous cardiac
monitoring. With daily hydrocortisone doses of 50 mg or
more, mineralocorticoid replacement in primary adrenal
insufficiency can be reduced because this dose is
equivalent to 0·1 mg fludrocortisone.
68
In case of newly
diagnosed (or suspected) adrenal insufficiency,
treatment must not be delayed by diagnostic work-up.
Baseline blood samples for ascertainment of cortisol and
ACTH (optional: plasma renin activity, aldosterone,
dehydroepiandrosterone sulphate) should be drawn
immediately before hydrocortisone administration.
Ok, I'm exhausted. If you don't pull yourself together and fight for extra HC, needles, Solu-Cortef Actovial and Zofran as well as print out the Emergency Protocol and How to give an Injection, you are NOT TAKING RESPONSIBILITY FOR YOURSELF and accepting that you might die if something bad happens to your (food poisoning on a Saturday night, car accident, broken bone while hiking or camping).
