Adrenal Crisis

Precautions

Ensure the medical history is up to date regarding steroid medication, adrenal insufficiency, or Addison’s disease. Check if the patient carries a steroid warning card, and if she/he carries a hydrocortisone emergency injection kit.

The Addison’s Foundation recommends all patients taking hydrocortisone (or prednisolone) to have a 100mg injection kit with them for emergency use only.

If the patient is being treated for a severe (i.e. systemic) infection of dental origin, an increased steroid dose should be also be considered, in addition to antibiotics.

Management of an Adrenal Crisis

This is unlikely to occur in a dental surgery in a patient not known to have adrenal insufficiency – consider other diagnoses first. If you are sure of the diagnosis, the appropriate treatment is:

• Maintain airway, breathing, circulation.
• Call an ambulance.
• Consider administration of IV or IM Hydrocortisone 100mg, if carried in the emergency drug box, or if the patient carries an emergency hydrocortisone injection kit..

Administering hydrocortisone liquid in a standard syringe

Solu-Cortef, Act-o-Vial safety syringe emergency injection

Paramedic / hospital follow-up

The patient may need to be rehydrated with an intravenous drip containing sodium, glucose and dextrose. Also receive a hydrocortisone injection if not already given.

Any untreated underlying causes of the adrenal crisis, such as infection, will also be managed.