An adrenal crisis is life threatening and needs prompt treatment. If you think you or your loved one is experiencing crisis symptoms do not wait! CALL 911. If you have an emergency injectable use it per your endocrinologist’s instructions, and get to the ER! Contact your endo to alert him/her so they can inform the ER staff of your imminent arrival.
Signs and Symptoms of Adrenal Crisis
Not all symptoms will be present
- Shock-like symptoms
- Nausea or vomiting/diarrhea
- Neurological deficits: behavior changes, confusion, difficulty speaking, slurred speech
- Pale, cold, clammy skin, shivering
- Rapid pulse and/or breathing
- Low blood sugar
- Low OR high blood pressure
- Pain: abdominal, back, flank, legs.
- Cardiovascular collapse/stroke
Low sodium levels can lead to delirium and abnormal brain function. As a result patients may seem to be under the influence. This is a sign of adrenal crisis and must be treated immediately.
Without proper and immediate treatment the patient will suffer cardiovascular collapse, stroke and death.
1. Administer/assist with patient provided emergency injection. If not available use one locally approved steroid IM/IV. Hydrocortisone is the preferred emergency glucocorticoid. Be aware, many patients also lack mineralocorticoid coverage.
hydrocortisone methylprednisolone dexamethasone
Adult 100 mg 125 mg 4 mg
Pediatric 2 mg/kg 2 mg/kg 0.03 – 0.15 mg/kg
(max of 100 mg) (max of 125 mg) (max of 4 mg)
2. Check a capillary blood glucose. If blood glucose is less than 70 mg/dl. refer to local diabetic protocols.
3. Administer NS fluids per local protocol. Refer to local hypotension shock protocol.
4. Refer to local cardiac arrest protocol.
Injection Instructions Video: This youtube video by the Succeed Clinic in OK walks you through the steps to inject. Although the video was made for those with Congenital Adrenal Hyperplasia the instructions on how to inject are the same for anyone. Be sure to ask your physician about the circumstances in which you would need an injection.
Written Injection Instructions : These instructions are from Sydney Children’s Hospital other instructions can be found with google searches.
EMERGENCY LETTERS and Instructions. BE SURE TO KEEP ONE WITH YOU AT ALL TIMES!
Emergency Letter: A letter to take to the emergency room with you written for AIU by Professor Peter Hindmarsh.
Emergency Letter: A letter to take the the emergency room written by the Pediatric Endocrine Society Board of Directors, November 2015.
Emergency Letters Translated into several languages thanks to the Addison’s Disease Self-Help Group. Languages available: Cantonese, French, German, Greek, Italian, Mandarin, Portuguese, Russian, Spanish, and Thai.
Adrenal Crisis Pathway: This graphic flowchart illustrates the events that can occur during an adrenal crisis. These events can happen in 30 minutes or less. Factors such as the overall health of the individual, mechanism of injury, and severity of illness all play a part. Sometime a crisis can take longer to develop. It’s important to have a conversation with your physician about what to do in an emergency situation.
Illness Flow Chart: This helpful chart created by Professor Hindmarsh can help parents with children who are ill but is not meant to be used as a diagnostic tool. Parents unsure of what to do during a child’s illness should always contact a physician.
Great Info from the NIH on managing AI. For those having difficulty getting a prescription for Solu-Cortef® the second page clearly states that all with adrenal insufficiency should carry the injection.
Another from the NIH on stress dosing and illness.