Adrenal Crisis Information
Diagnostic measures should never delay treatment and if adrenal crisis is suspected, treatment should be initiated WITHOUT DELAY. Short-term administration of high doses of glucocorticoids is never harmful but failure to treat adrenal crisis can result in the death of the patient.
If you suspect established or developing adrenal crisis in a patient:
Please immediately inject 100mg hydrocortisone i.v. or i.m. followed by rapid rehydration with i.v. administration of 0.9% saline solution (or equivalent).
Please maintain the patient on hydrocortisone at a dose of 200mg hydrocortisone per 24 hours (preferably by continuous i.v. infusion, alternatively by i.v. or i.m. injection of 50mg hydrocortisone every 6 hours) until clinical recovery and further guidance by an endocrinologist.
Adrenal crisis can be a manifestation of previously undiagnosed adrenal failure.
Adrenal crisis can also occur in patients with known adrenal insufficiency if existing cortisol replacement does not meet the increased need for cortisol, e.g. due to illness with fever, persistent vomiting or diarrhoea, trauma or childbirth. Preparation for invasive diagnostic procedures such as colonoscopy and surgery requiring general anaesthesia are further risk factors for adrenal crises.
To prevent adrenal crisis in all these situations, hydrocortisone needs to be administered and maintained as per above.
Do not hesitate to give high doses of hydrocortisone to a pregnant woman; hydrocortisone is inactivated in the placenta and does NOT affect the unborn baby. However, failure to treat a pregnant woman with adrenal insufficiency can result in death of mother and/or loss of the child.
Infants up to 1 year may be given 25mg hydrocortisone intravenously; children 1 to 5 years, 50mg; 6 to 12 years, 100mg (1ml). This dose can be repeated three or four times in 24 hours depending upon the condition being treated and the patient's response.
NHS Steroid Emergency card
The NHS Steroid Emergency Card is now available for organisations to order:
- Secondary Care: Xerox online portal
You may need to raise a Non-Catalogue Requisition in Oracle, selecting supplier as XEROX, and we can process the requisition by raising the order with NHS Forms. Cost is £2.65 excluding VAT for 100 cards. One unit is 100 cards.
- Primary Care: PCSE online portal
Patients can also download a pdf version if they wish. Some patients are also uploading the pdf version as the lock screen on their mobile phones, to show health care professionals in a medical emergency.
Read the guidance on the prevention and emergency management of adult patients with adrenal insufficiency that accompanies the NHS Steroid Emergency Card.
This card and its associated guidance is intended for use by adults (16+). Infants up to 1 year may be given 25mg hydrocortisone intravenously; children 1 to 5 years, 50mg; 6 to 12 years, 100mg (1ml). This dose can be repeated three or four times in 24 hours depending upon the condition being treated and the patient's response.
If you need further information please email the British Society for Paediatric Endocrinology and Diabetes (BSPED) who are discussing separate guidance for children and adolescents.
Queries about the blue steroid card and London Respiratory Network Card
The new NHS Steroid Emergency Card is a prompt to healthcare professionals when patients are admitted in crisis/as an emergency or when undergoing surgery/procedure, to ensure steroid treatment is given appropriately and promptly. The card clearly outlines first management steps in an emergency. In addition, the card contains a QR code that links to further specialist advice.
The blue Steroid Treatment Card and the London Respiratory Network Card are unaffected by the introduction of the NHS Steroid Emergency Card. Patients should keep these if advised by their medical team whilst implementation of the new steroid emergency card takes place.
Related links for patient information
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