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Warning-sign checks

Acute adrenal crisis: when to get help

Go through these in order and stop at the first one that applies. If you are reading this for someone else, answer for them.

  1. 1

    Is any of this happening now?

    Call 911

    At follow-up visits, patients can review their daily replacement treatment, sick-day instructions, emergency injection technique, and medical alert identification.

    The clinician may also check blood pressure, symptoms, electrolytes, and signs that steroid replacement is too low or too high.

    Emergency care is different from routine follow-up.

    Severe weakness, fainting, confusion, repeated vomiting, inability to take steroid medicine, or rapidly worsening illness requires immediate emergency assessment.

    An emergency injection, when prescribed, is not a replacement for evaluation in an emergency department.

    And for anyone, someone who:

    • is bleeding heavily and it will not stop with firm pressure
    Other emergency signs, for anyone
    • Someone who is struggling to breathe, gasping, choking, or cannot get words out
    • Someone who has chest pain, tightness or pressure lasting more than a few minutes
    • Someone who has sudden weakness or drooping on one side of the face or body, slurred speech, or sudden confusion
    • Someone who is unconscious, or cannot be woken
    • Someone who has had a seizure that will not stop, or does not wake up afterwards
    • Someone who has lips or skin that look pale, blue, grey or blotchy
    • Someone who you believe has taken an overdose or swallowed something poisonous
  2. 2

    Is any of this happening?

    Be seen today

    Patients should contact their healthcare team promptly if they have repeated episodes of vomiting, frequent low blood pressure, worsening weakness, or difficulty following their sick-day plan.

    And for anyone, someone who:

    • has a wound that is hot, spreading red, or leaking pus
  3. 3

    Does any of this apply?

    Book an appointment

    After discharge, routine follow-up should review the cause of the crisis and whether the diagnosis of adrenal insufficiency has been fully established.

    A primary care clinician and an endocrinologist, a doctor who specializes in hormone conditions, may both be involved.

    Advice is also needed before planned surgery, invasive procedures, or pregnancy and childbirth because steroid needs may change.

Every sign above is quoted from the sofidex article on Acute adrenal crisis. If you are not sure, err upward — it is always reasonable to be checked.