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Policy
Patients
may present identifying themselves as having Addison's disease, adrenal
insufficiency, hypopituitarism or being on long term steroid therapy -
either by way of their history, wearing a medic alert bracelet or
during review of patient's medications.
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Procedure
1.
Symptoms:
Patients Presenting with
 Vomiting, diarrhea,
decreased urine output
Clinical signs of dehydration
Heart Rate > 100
Systolic blood pressure less
than 120
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2. Action:
Draw CBC, glucose, electrolytes, calcium STAT
Patient to be seen by
physician within 15 minutes
Physician management:
Normal saline (500 cc per
hour for the first hour, monitor Fluid status, blood pressure, heart
rate)
Hydrocortisone (Solu-Cortef)
(100 mg IV bolus)
Hydrocortisone (Solu-Cortef)
(100 mg IV Q8h)
If the patient
condition stabilizes, tolerating oral fluids and normal vital signs
then discharge with oral glucocorticoids tripled. Patient to contact
their endocrinologist or family physician within 48 hours.
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3. Mild
Cases:
In milder cases, dose can be either doubled or tripled depending on the
physician's judgement.
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