Self care advice for patients with Addison's disease

Patients should be aware of the potential life threatening consequences, if glucocorticoid replacement is inadequate especially during physical stress (intercurrent illness, surgery or severe injury) (1)

Patients should be able to identify early symptoms of a crisis so that early self administration of 100mg of hydrocortisone IM will often stabilise the acute episode (1)

Patients (advice with respect to adults) must know how to adjust their medication during the following instances:

• fever of more than 37.5 C - double the normal dose of hydrocortisone
• after vomiting - 20mg hydrocortisone immediately and sip rehydration/electrolyte fluids
• on vomiting twice - use the emergency injection and inform a doctor
• after injury - 20mg hydrocortisone orally immediately

Advice patients that:

• they are entitled for free medication and the repeat prescription should be renewed in good time so that a month's reserve supply is maintained
• when travelling take an extra supply of medication together with an emergency injection kit
• if on antibiotic treatment they need to double the their normal dose
• it is important to carry emergency treatment instructions on record for all Addison's patients e.g. - MedicAlert bracelet (1)

Note:

• it is recommended to supply the patient with 3-5 vials injectable hydrocortisone in case of breakages (1)

Reference:

• 1. Wass, J., Howlett, T., Arlt, W. et al. Caring for the Addison's patient: information for GPs. Addison's Disease Self Help Group 2007