| Action Point . | Intervention . |
|---|---|
| Identify and define the problem | Steroid emergency card (check that card is available and up to date) |
| Medical alert bracelet or necklace: “Adrenal insufficiency – needs steroids!” | |
| Educate patient (and partner/parents) | Sick day rule 1: need to double the routine oral glucocorticoid dose when the patient experiences fever or illness requiring bed rest; when requiring antibiotics for an infection; or before a small outpatient procedure (eg, dental work) |
| Sick day rule 2: need to inject a glucocorticoid preparation im or iv in case of severe illness, trauma, persistent vomiting, when fasting for a procedure (colonoscopy!), or during surgical intervention. | |
| 100 mg hydrocortisone iv, im, or sc followed by 200 mg hydrocortisone per continuous iv infusion, alternatively repeated bolus doses (iv or im) every 6 h | |
| Give special attention to: | Explaining the rationale for dose adjustment in stress/sickness |
| Discussing the situations requiring dose adjustment | |
| Discussing symptoms and signs of emergent adrenal crisis | |
| Teaching parenteral self-administration of glucocorticoid preparation | |
| Enforcing the need to go to hospital after emergency injection | |
| Provide patient with: | Sufficient supply of hydrocortisone and fludrocortisone (accounting for possible sick days) |
| Hydrocortisone emergency injection kit prescription (vials of 100 mg hydrocortisone sodium, syringes, needles; alternatively, also hydrocortisone or prednisolone suppositories) | |
| Leaflet with information on adrenal crisis and hospitalization to be shown to health care staff; clearly advise regarding the need to inject 100 mg hydrocortisone immediately iv or im, followed by continuous infusion of 200 mg/24 h | |
| Emergency phone number of endocrine specialist team | |
| Follow-up | Reinforce education and confirm understanding during each follow-up visit (at least annually in a patient without specific problems or recent crises; otherwise, more frequently) |
| Action Point . | Intervention . |
|---|---|
| Identify and define the problem | Steroid emergency card (check that card is available and up to date) |
| Medical alert bracelet or necklace: “Adrenal insufficiency – needs steroids!” | |
| Educate patient (and partner/parents) | Sick day rule 1: need to double the routine oral glucocorticoid dose when the patient experiences fever or illness requiring bed rest; when requiring antibiotics for an infection; or before a small outpatient procedure (eg, dental work) |
| Sick day rule 2: need to inject a glucocorticoid preparation im or iv in case of severe illness, trauma, persistent vomiting, when fasting for a procedure (colonoscopy!), or during surgical intervention. | |
| 100 mg hydrocortisone iv, im, or sc followed by 200 mg hydrocortisone per continuous iv infusion, alternatively repeated bolus doses (iv or im) every 6 h | |
| Give special attention to: | Explaining the rationale for dose adjustment in stress/sickness |
| Discussing the situations requiring dose adjustment | |
| Discussing symptoms and signs of emergent adrenal crisis | |
| Teaching parenteral self-administration of glucocorticoid preparation | |
| Enforcing the need to go to hospital after emergency injection | |
| Provide patient with: | Sufficient supply of hydrocortisone and fludrocortisone (accounting for possible sick days) |
| Hydrocortisone emergency injection kit prescription (vials of 100 mg hydrocortisone sodium, syringes, needles; alternatively, also hydrocortisone or prednisolone suppositories) | |
| Leaflet with information on adrenal crisis and hospitalization to be shown to health care staff; clearly advise regarding the need to inject 100 mg hydrocortisone immediately iv or im, followed by continuous infusion of 200 mg/24 h | |
| Emergency phone number of endocrine specialist team | |
| Follow-up | Reinforce education and confirm understanding during each follow-up visit (at least annually in a patient without specific problems or recent crises; otherwise, more frequently) |
Adapted from I. Bancos, et al: Diagnosis and management of adrenal insufficiency. Lancet Diabetes Endocrinol. 2015;3:216–226 (122), with permission. © Elsevier Limited.
| Action Point . | Intervention . |
|---|---|
| Identify and define the problem | Steroid emergency card (check that card is available and up to date) |
| Medical alert bracelet or necklace: “Adrenal insufficiency – needs steroids!” | |
| Educate patient (and partner/parents) | Sick day rule 1: need to double the routine oral glucocorticoid dose when the patient experiences fever or illness requiring bed rest; when requiring antibiotics for an infection; or before a small outpatient procedure (eg, dental work) |
| Sick day rule 2: need to inject a glucocorticoid preparation im or iv in case of severe illness, trauma, persistent vomiting, when fasting for a procedure (colonoscopy!), or during surgical intervention. | |
| 100 mg hydrocortisone iv, im, or sc followed by 200 mg hydrocortisone per continuous iv infusion, alternatively repeated bolus doses (iv or im) every 6 h | |
| Give special attention to: | Explaining the rationale for dose adjustment in stress/sickness |
| Discussing the situations requiring dose adjustment | |
| Discussing symptoms and signs of emergent adrenal crisis | |
| Teaching parenteral self-administration of glucocorticoid preparation | |
| Enforcing the need to go to hospital after emergency injection | |
| Provide patient with: | Sufficient supply of hydrocortisone and fludrocortisone (accounting for possible sick days) |
| Hydrocortisone emergency injection kit prescription (vials of 100 mg hydrocortisone sodium, syringes, needles; alternatively, also hydrocortisone or prednisolone suppositories) | |
| Leaflet with information on adrenal crisis and hospitalization to be shown to health care staff; clearly advise regarding the need to inject 100 mg hydrocortisone immediately iv or im, followed by continuous infusion of 200 mg/24 h | |
| Emergency phone number of endocrine specialist team | |
| Follow-up | Reinforce education and confirm understanding during each follow-up visit (at least annually in a patient without specific problems or recent crises; otherwise, more frequently) |
| Action Point . | Intervention . |
|---|---|
| Identify and define the problem | Steroid emergency card (check that card is available and up to date) |
| Medical alert bracelet or necklace: “Adrenal insufficiency – needs steroids!” | |
| Educate patient (and partner/parents) | Sick day rule 1: need to double the routine oral glucocorticoid dose when the patient experiences fever or illness requiring bed rest; when requiring antibiotics for an infection; or before a small outpatient procedure (eg, dental work) |
| Sick day rule 2: need to inject a glucocorticoid preparation im or iv in case of severe illness, trauma, persistent vomiting, when fasting for a procedure (colonoscopy!), or during surgical intervention. | |
| 100 mg hydrocortisone iv, im, or sc followed by 200 mg hydrocortisone per continuous iv infusion, alternatively repeated bolus doses (iv or im) every 6 h | |
| Give special attention to: | Explaining the rationale for dose adjustment in stress/sickness |
| Discussing the situations requiring dose adjustment | |
| Discussing symptoms and signs of emergent adrenal crisis | |
| Teaching parenteral self-administration of glucocorticoid preparation | |
| Enforcing the need to go to hospital after emergency injection | |
| Provide patient with: | Sufficient supply of hydrocortisone and fludrocortisone (accounting for possible sick days) |
| Hydrocortisone emergency injection kit prescription (vials of 100 mg hydrocortisone sodium, syringes, needles; alternatively, also hydrocortisone or prednisolone suppositories) | |
| Leaflet with information on adrenal crisis and hospitalization to be shown to health care staff; clearly advise regarding the need to inject 100 mg hydrocortisone immediately iv or im, followed by continuous infusion of 200 mg/24 h | |
| Emergency phone number of endocrine specialist team | |
| Follow-up | Reinforce education and confirm understanding during each follow-up visit (at least annually in a patient without specific problems or recent crises; otherwise, more frequently) |
Adapted from I. Bancos, et al: Diagnosis and management of adrenal insufficiency. Lancet Diabetes Endocrinol. 2015;3:216–226 (122), with permission. © Elsevier Limited.
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