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Adrenal Crisis Treament
Is it safe to use an adequate amount of 1% topical hydrocortisone cream to stop an adrenal crisis instead of a 100mg of solucortef. I would do just about anything to keep from weaning down from 100mg again. It's miserable.
I thought I was having tetany (low calcium) so I was not quite with it, which of course is what happens when I have a crisis my brain is total mush.
My fever was only low grade - had it been higher I would have been toast. Then they kept me as my BP stayed in the toilet despite 3 bags full open (my hands blew up like balloons!) and I had an other bag over the next day.
It does not take much to drop us, eh?
PICC line - crud! I only had that once that was not pleasant.
My fever was only low grade - had it been higher I would have been toast. Then they kept me as my BP stayed in the toilet despite 3 bags full open (my hands blew up like balloons!) and I had an other bag over the next day.
It does not take much to drop us, eh?
PICC line - crud! I only had that once that was not pleasant.
I would've been dead .....my veins were collapsed and blood pressure was down to 63/38 and dropping steadily. How can you wait 5 hours for the injection? My body was in hypovolemic shock and the stupid ER nurses kept saying but we can't get the needle in...then we can't get any blood....and they did nothing. I had to yell to get to finally get them to add solucortef to the PICC line once they got it in my arm after 20 minutes of puncturing me. I didn't have an injection kit with me. That crap won't ever happen again. I pray I never go to the ER without injecting first or using HC cream.
I will agree on the far behind. Sad.
My trip to ER last Aug - that doc called endo ASAP and got me my shot in minutes... last week, it took 5 hours! Lucky I was not critical at the time. It is on my records that I don't have adrenals so the crisis *should not* be in dispute - but they still don't understand what it is!
My endos will give it every 6! Usually it is a 50mg dose, and when I have come down enough not to need it, it means I will be hanging off the ceiling like a bat.
My trip to ER last Aug - that doc called endo ASAP and got me my shot in minutes... last week, it took 5 hours! Lucky I was not critical at the time. It is on my records that I don't have adrenals so the crisis *should not* be in dispute - but they still don't understand what it is!
My endos will give it every 6! Usually it is a 50mg dose, and when I have come down enough not to need it, it means I will be hanging off the ceiling like a bat.
In Europe they give solucortef every 6 hours.....here in the US they will only give every 8 hours. We are so far behind other countries in endocrine knowledge and research.
I think the cream lasts as long as the injectable....it is absorbed into the blood stream immediately through the capillaries.
I only used it to stop a crisis...one time and it worked beautifully...the shaking chills stopped within 5 minutes and I felt human again. I never lost bowel control or anything. Thank GOD!
I have a letter that tells the ER doc what to do. He actually questioned if I adrenal insufficiency....like who in the #€|| would make something like that up??? Most people don't even have a clue there is such a thing. That stupid doc actually waited on the lab to run serum cortisol while I was yelling I was in trouble while I watched my blood pressure steadily dropping.
I have a letter that tells the ER doc what to do. He actually questioned if I adrenal insufficiency....like who in the #€|| would make something like that up??? Most people don't even have a clue there is such a thing. That stupid doc actually waited on the lab to run serum cortisol while I was yelling I was in trouble while I watched my blood pressure steadily dropping.
Oh cripes.
Does your doc give you a letter to carry in to the ER with instructions? Not that this always works - I have had my letter ignored when I had a resident who was convinced I was not having an adrenal crisis ergo he could ignore all the data and almost killed me.
I have never heard of using the cream this way at all. How often do you have to use it?
Does your doc give you a letter to carry in to the ER with instructions? Not that this always works - I have had my letter ignored when I had a resident who was convinced I was not having an adrenal crisis ergo he could ignore all the data and almost killed me.
I have never heard of using the cream this way at all. How often do you have to use it?
I can't do a bouncy wean as it causes much pain. I do a straight wean and haven't ever done it effector because each time I end up with more HPA suppressionn and in more pain. The cream is absorbed immediately and does stop a crisis immediately. I tested the waters last time and the shaking chills stopped in less than 5 minutes and all vitals returned to normal. It was effective enough that I didn't lose bowel control....thank God!
A stomach virus or food poisoning resulting in dehydration always sends me into crisis shortly after vomiting begins as it causes hypovolemic shock. Last time I even had Raymauds and the stupid ER nurse tried to tell me I smoked cigarettes and that's what caused it. They didn't even know that veins collapse and nails turn purple/black in adrenal crisis. They almost let me die. My blood pressure was down to 60/38 before I got the injection and had to yell for it.
A stomach virus or food poisoning resulting in dehydration always sends me into crisis shortly after vomiting begins as it causes hypovolemic shock. Last time I even had Raymauds and the stupid ER nurse tried to tell me I smoked cigarettes and that's what caused it. They didn't even know that veins collapse and nails turn purple/black in adrenal crisis. They almost let me die. My blood pressure was down to 60/38 before I got the injection and had to yell for it.
I can't do a bouncy wean as it causes much pain. I do a straight wean and haven't ever done it effector because each time I end up with more HPA suppressionn and in more pain. The cream is absorbed immediately and does stop a crisis immediately. I tested the waters last time and the shaking chills stopped in less than 5 minutes and all vitals returned to normal. It was effective enough that I didn't lose bowel control....thank God!
A stomach virus or food poisoning resulting in dehydration always sends me into crisis shortly after vomiting begins as it causes hypovolemic shock. Last time I even had Raymauds and the stupid ER nurse tried to tell me I smoked cigarettes and that's what caused it. They didn't even know that veins collapse and nails turn purple/black in adrenal crisis. They almost let me die. My blood pressure was down to 60/38 before I got the injection and had to yell for it.
A stomach virus or food poisoning resulting in dehydration always sends me into crisis shortly after vomiting begins as it causes hypovolemic shock. Last time I even had Raymauds and the stupid ER nurse tried to tell me I smoked cigarettes and that's what caused it. They didn't even know that veins collapse and nails turn purple/black in adrenal crisis. They almost let me die. My blood pressure was down to 60/38 before I got the injection and had to yell for it.
What happened that put you in ER? I guess I am lucky in that a fast taper after one day is not an issue for me. So after a minor surgery or for the fever that the blasted down with fluids, I tapered back immediately, but if your body needed more...
I don't think the cream would work... I am not sure about the absorption rates. That is why you have to get an IV or IM med. I would love to use a cream instead but I don't know if you can really rely on the cream to give you a reliable dose, plus being able to titrate it down reliably.
So it sounds like you must wean - do you wean straight or do a bouncy wean (down down up down down up etc. or some variation) to help you with the pain?
Pred is evil... :)
I don't think the cream would work... I am not sure about the absorption rates. That is why you have to get an IV or IM med. I would love to use a cream instead but I don't know if you can really rely on the cream to give you a reliable dose, plus being able to titrate it down reliably.
So it sounds like you must wean - do you wean straight or do a bouncy wean (down down up down down up etc. or some variation) to help you with the pain?
Pred is evil... :)
Interesting comments. The 1% cream is absolutely strong enough. 1 gram has 10mg. A teaspoon has 5 grams hence 50mg of HC in a mere teaspoon which can be put on the back of the hands and absorbed in less than the amount of time it takes to inject. I have to wean down very slowly after 100mg of solucortef as it causes steroid withdrawal syndrome and steroid myopathy for me and that is very painful. I weaned from 50mg of HC over the course of a week after last crisis and a month later I have more HPA suppression. I have SAI from a prescription of that evil Prednisone...it ruined my life. I've been battling this ordeal for 4+ years now.
The last time an ER doc told me to go back to my regular dose the next day I listened to him and what an idiot he was....in 2 weeks I couldn't walk from ligaments tearing apart in my feet. My regular doc had to put me on 40 of HC for 6 weeks to undo the damage and it took me 6 months to wean down to a reasonable daily dose.
The last time an ER doc told me to go back to my regular dose the next day I listened to him and what an idiot he was....in 2 weeks I couldn't walk from ligaments tearing apart in my feet. My regular doc had to put me on 40 of HC for 6 weeks to undo the damage and it took me 6 months to wean down to a reasonable daily dose.
NO. Let me state that again. NO.
NO NO NO.
Oh. Sorry. I don't want you to die.
I just had a crisis... last Tuesday. If I just go up one day - I frankly don't wean. I don't have to. Now this is *my body* - you have to learn how you do. Usually if you need the 100mg, you use it and you are fine, and you can taper pretty quickly, in a day or two or three.
It goes like this - if I go up a long time, I go down a long time. But for a rapid up, I can rapidly go down. I likely used it and my body is not used to it. BUT do keep an eye on yourself in case you need extra salt, dosing etc. But I was put in the hospital and even my doc did not dose me extra the next day. I was simply put on my regular dose the next day.
Weaning dose bite... I cannot blame you... but the cream just cannot work - it is not absorbed the same way and is not strong enough to help you.
NO NO NO.
Oh. Sorry. I don't want you to die.
I just had a crisis... last Tuesday. If I just go up one day - I frankly don't wean. I don't have to. Now this is *my body* - you have to learn how you do. Usually if you need the 100mg, you use it and you are fine, and you can taper pretty quickly, in a day or two or three.
It goes like this - if I go up a long time, I go down a long time. But for a rapid up, I can rapidly go down. I likely used it and my body is not used to it. BUT do keep an eye on yourself in case you need extra salt, dosing etc. But I was put in the hospital and even my doc did not dose me extra the next day. I was simply put on my regular dose the next day.
Weaning dose bite... I cannot blame you... but the cream just cannot work - it is not absorbed the same way and is not strong enough to help you.
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