What is an Addison crisis and how do you react?
Stress can develop in any situation where extra demands, either physical or mental, are made on a person. Some examples of situations where stress may occur are: illness (especially when this is accompanied by fever), an accident, a long bike ride, exams, the death of a loved one, and so on.
Stress is a very individual question; these are just a few broad examples of occasions on which it could occur. Under normal circumstances, the adrenal glands produce extra cortisol in times of stress. If the adrenal glands are not functioning then extra cortisone or hydrocortisone needs to be given.
The following points are important:
- If the stress situation can be anticipated (e.g. exams, a funeral or a children’s party) then it is advisable to take (or give) the extra dosage of cortisone or hydrocortisone in advance.
- If you know well in advance that a stressful situation is likely to occur then it is advisable to discuss this with your doctor beforehand, e.g. planned surgical operations, holidays abroad, moving house, etc.
- If in doubt it is better to increase the dosage of cortisone or hydrocortisone. A one-off higher dosage will not do any harm but not increasing it could, in some cases, actually have serious consequences.
- You should always follow the instructions of the treating physician. If you are unable to consult him for some reason, the examples below describe various stress situations and provide guidelines for cortisone/hydrocortisone dosages
Situations of slight stress,
e.g. a slight cold but no raised temperature: take no extra medicine unless you know from experience that a slightly higher dosage is necessary (in adults, for example, an extra 10% of the average daily dose would generally be 2.5-5 mg or 20% would be 5-10 mg).
Situations of moderate stress,
e.g. raised temperature of between 375 and 385 °C, vomiting and/or diarrhea, vaccination, influenza or other infections, exams: double the dosage of cortisone/hydrocortisone in adults and triple the dosage in children. If the normal dosage is 15-5-5 mg hydrocortisone per day, this will then be 30-10-10 mg per day for adults.
Situations of serious stress,
e.g. temperature above 385 °C, surgical operation, a visit to a dental surgeon or in cases of accident or serious injury: adults should take three times the dosage (x3) but multiply the dosage by five (x5) for a child. Always consult your doctor. If necessary (after vomiting for instance) a high dose of hydrocortisone (100 mg Solu-Cortef®) may need to be injected.
Minor procedures. A single 100 mg dose of hydrocortisone or 25 mg prednisolone administered intravenously (i.v.) or intramuscularly (i.m.). Major and minor operations:
- One hour preoperatively and again postoperatively 100mg of hydrocortisone or 25 mg prednisolone administered i.v. or i.m.
- On the day of operation, another two doses of hydrocortisone 50 mg or prednisolone 12.5 mg should be administered i.v. or i.m. On the first and second postoperative days 50 mg hydrocortisone or 12.5 mg prednisolone i.v. or i.m. every 6 hours.
- In the absence of complications resume oral substitution, otherwise increase the dosage of hydrocortisone and check blood pressure and electrolyte balance frequently.
- In the case of major operations, corticosteroids must also be administered after the operation, e.g. 50 mg hydrocortisone every 6 hours on the first and second days. If medication can then be taken orally, reduce dose of corticosteroids over the course of one week to normal substitution levels – unless complications arise.
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