Steroid Ƒe Asiɖeɖe le Adrenal Crisis, Dɔnɔ Ŋkeke Hydrocortisone Sewo, Kple Solu-Cortef Dɔwɔwɔ¶

Ame miliɔn geɖe noa corticosteroid siwo woŋlɔ na amewo le xexeame godoo (abe prednisone, prednisolone, methylprednisolone, dexamethasone, alo hydrocortisone ene) na asrã, COPD, ƒunukpeƒetetedɔ, lupus, dɔgbo ƒe dɔléle si naa dɔdzẽ, polymyalgia rheumatica, ŋutinuwo dodo na ame, alo kansa, evɔ ame bubuwo ya nɔa te ɖe steroid siwo wotsɔ ɖɔa li wo gbesiagbe dzi hena gbãtɔ Addison ƒe dɔléle alo pituitary ƒe dɔmawɔmawɔ nyuie. Ɣesiaɣi si ame aɖe no supraphysiologic steroid ƒe agbɔsɔsɔme si wu kwasiɖa 2 va ɖo 3 la, eƒe ahɔhɔ̃ kple adrenal glands tsia dzɔdzɔme cortisol wɔwɔ, nɔnɔme si woyɔna be tertiary (glucocorticoid-induced) adrenal insufficiency. Ne ame ma tɔ kpata alo woƒe steroid-tikeawo vɔ, alo ŋutilã me nuteɖeamedzi kpata aɖe abe dɔgbo me dɔlékui (ʋuʋudedi kple aɖuɖɔtoe), dzoxɔxɔ sesẽ, asrã, ŋeŋe, alo amekoko evɔ womexɔ "nuteɖeamedzi-dose" steroid bubu o la, woƒe ʋu ƒe sisi kple sukli ate ŋu aɖiɖi ŋutɔ azu adrenal crisis (acute adrenal insufficiency) si wua ame. le gaƒoƒo geɖe me. Ƒo ka na wò nutoa me xexlẽdzesi kpata to míaƒe... xexlẽdzesi siwo wozãna kpata agbalẽdzraɖoƒe eye woado hydrocortisone miligram 100 ɖe lãmekawo me enumake xɔname, abe alesi lãmenugbagbeviwo ƒe nɔnɔme kpata sia si xɔa ɣeyiɣi sesẽ la srɔ̃nɛ enuenu ene sepsis kple septic shock ƒe ʋuʋu, . suklidɔ ƒe nɔnɔme kpata siwo me suklidɔ ƒe agbɔsɔsɔ dzi ɖena kpɔtɔna, kple Addison ƒe dɔléle ƒe kuxia.

Wɔ esia fifia¶

1. Ƒo ka na wò nutoa me ƒe xexlẽdzesi kpata enumake eye nàgblɔ be "Suspected Acute Adrenal Crisis, Needs IV Hydrocortisone and 0.9% Normal Saline": Ƒo 911 le United States kple Canada, 112 le Europa Dukɔwo ƒe Habɔbɔ bliboa me, 999 le United Kingdom, 000 le Australia, alo kpɔ míaƒe dukɔwo dome xexlẽdzesi siwo wozãna kpata nyatakakadzraɖoƒe. Gblɔ na amesi ɖoe ɖa la tẽ be dɔnɔa nɔa te ɖe steroid zazã dzi (alo edzudzɔ steroid zazã atraɖii nyitsɔ laa) eye wòle ʋu ƒe sisi ƒe ʋuʋu me, elabena ne menye nenema o la, ambulance triage si wozãna ɖaa ate ŋu abu vodadatɔe be ʋuʋudedi kple kuviawɔwɔ nye dɔgbo me dɔléle si wowɔna edziedzi.
2. Mlɔ amea ɖe akɔta gbadzaa eye nàkɔ afɔwo ɖe dzi, alo nànɔ axadzi ƒe hayahaya ƒe nɔnɔme me ne èle ʋu ɖum alo le alɔ̃ dɔm: Mègaɖe mɔ gbeɖe be dɔnɔ si ƒe tagbɔ le ʋuʋum, si ƒe mo biã, alo esi ƒe ʋusɔgbɔdɔ le ʋuka me ƒe kuxi si wosusu be eƒe adrenal ƒe kuxi le la nanɔ tsitrenu alo atsi tre gbeɖe o, elabena ʋu si ƒo ƒu kpata le orthostatic me ate ŋu ana wòatsi dzodzodzoe enumake eye dzi natɔ te. Ne woƒe lãme le ʋuʋum, wole ʋuʋum, alo wotɔtɔ la, ƒo wo ɖe woƒe axadzi be woƒe yaƒoƒomɔ̃a nakɔ.
3. Di dɔnɔa ƒe Emergency Hydrocortisone Injection Kit (alo steroid-tu siwo woano) kple Steroid Emergency Card: Kpɔ woƒe gakotoku, akplo, zãdokeli, alo atikedzraɖoƒe ɖa be Solu-Cortef Act-O-Vial (100 mg / 2 mL hydrocortisone sodium succinate) alo 100 mg / 1 mL hydrocortisone sodium phosphate liquid ampoule, tsɔ kpe ɖe woƒe NHS Steroid Emergency Card, Europa Steroid Card, alo United States Endocrine Society/NADF Emergency Protocol Letter dzĩ ŋu.
4. Na hydrocortisone miligram 100 si wodona ɖe lãmeka me nawɔ dɔ eye nàdoe ɖe ata ƒe titina gotagome enumake: Ne hydrocortisone dodo kpata ƒe dɔwɔnu le dɔnɔa si la, te Solu-Cortef Act-O-Vial ƒe plastik si le etame ƒe nutrenu la ɖe anyi be nàtsɔ tsi si me dɔlékui mele o la aƒu gbe ɖe aŋɔxɔ si le ete la me, nàtrɔe blewuu hena sɛkɛnd 10 vaseɖe esime wòakɔ, hee yi dzi blibo mililita 2 (100 mg na ame tsitsiwo kple ƒewuivi siwo xɔ ƒe 12+; 50 mg [1.0 mL] na ɖevi siwo xɔ tso ƒe 1 va ɖo ƒe 11; 25 mg [0.5 mL] na vidzĩ siwo mexɔ ƒe 1 haɖe o), eye nàda aŋea le dzogoe 90-degree dzi ayi ata ƒe titina gota gome (vastus lateralis).
5. Na xɔname steroid siwo woano ne dɔnɔa nyɔ bliboe, meɖea ʋuʋudedi aɖeke o, eye atikekui aɖeke meli o: Ne dɔnɔ si dzudzɔ prednisone alo dexamethasone si nɔa anyi didi kpata la ƒe gbɔdzɔgbɔdzɔ kple taɖuame do ŋgɔ na xaxa maɖu, eye atike si woate ŋu ado nɛ mele esi o la, na woami woƒe nuteɖeamedzi ƒe agbɔsɔsɔme si woŋlɔ nɛ (abe hydrocortisone si woano 40 mg alo prednisone/prednisolone) si woano mg 10 va ɖo 20) kple tsi ate ŋu axe mɔ na wo ne dɔnɔdzikpɔʋua le mɔ dzi. Mègade atikekui alo tsi ame si le alɔ̃ dɔm, si tɔtɔ, alo le ʋuʋum vevie la ƒe nu me gbeɖe o.
6. Dada sukli si wosusu be eɖiɖi le ʋu me (suklidɔ ƒe agbɔsɔsɔ si mede ame dzi o) ne ènyɔ eye nète ŋu mia nu: Esi wònye be cortisol ƒe anyimanɔmanɔ xea mɔ na aklã me sukli ƒe wɔwɔ ta la, lé ŋku ɖe asibidɛ ƒe sukli si le ʋu me ŋu ne suklidzidzenu le asiwò. Ne sukli si le ʋu me mede 3.9 mmol/L (70 mg/dL) o (alo ne mita aɖeke meli o eye dɔnɔa le ʋuʋum, fifia le eŋu, eye wòle ŋudzɔ bliboe) la, na sukli si wozãna kabakaba le nu me gram 15 va ɖo 20 (atikutsetse me tsi mililita 120 va ɖo 180 alo soda si menye diet o edziedzi, alo sukli gel).

Nyametsotsoti: Steroid ƒe asiɖeɖe le eŋu, dɔléle ƒe ŋkeke ƒe nuteɖeamedzi ƒe agbɔsɔsɔme zazã, kple Solu-Cortef ƒe dɔwɔwɔ¶

flowchart TD
    Start["Dɔnɔ si le Steroid siwo nɔa anyi didi zãm (Kwasiɖa 2 va ɖo 3+ ƒe Prednisone, Prednisolone, Dexamethasone, Hydrocortisone, alo Steroid siwo Wogbɔna/Wodoa Dome na ame) ALOO Adrenal Insufficiency si Wonya"] --> TriggerCheck{"Nukae Nye Acute Trigger alo Nuɖeɖefia?"}

    TriggerCheck -->|"RED FLAG ADRENAL CRISIS SIGNS: 1. Aɖuɖɔtoe si nɔa anyi ɖaa (eɖea aɖuɖɔ zi 2+) alo aɖuɖɔtoe si sɔ gbɔ 2. Taɖuame sesẽ, alɔ̃madɔmadɔ, systolic BP si mede 90 mmHg o, alo ŋutigbalẽ si le blɔ 3. Tɔtɔ, kuviawɔwɔ si gbɔ eme, nuƒoƒo ƒuƒlu, alo alɔ̃madɔmadɔ 4. Ƒodo sesẽ si womeɖe o, axadzi, alo akɔtave 5. Nuveviwɔame gã, gbagbã, alo steroid ƒe dzudzɔ kpata kple eƒe anyidzedze"| CrisisProtocol["ADRENAL CRISIS RESCUE ENAME: 1. Mlɔ dɔnɔa ɖe anyigba gbadzaa (alo mlɔ axadzi ƒe hayahaya ƒe nɔnɔme ne ele ʋuʋum alo le alɔ̃ dɔm) 2. Na Solu-Cortef Act-O-Vial nawɔ dɔ eye nàdo IM ɖe gota ƒe ata titina FIFIA: - Ame tsitsiwo kple Ƒewuiviwo (ƒe 12+): 100 mg (2 mL) - Ðeviwo (ƒe 1 va ɖo 11): 50 mg (1 mL) - Vidzĩwo (siwo mexɔ ƒe 1 haɖe o): 25 mg (0.5 mL) 3. Ƒo ka na 911 / 112 / 999 STAT: Bia Dɔnɔdzikpɔla IV 0.9% Normal Saline (1,000 mL bolus) + Kɔdzi Ʋuɖoɖo"]

    TriggerCheck -->|"Steroid siwo nɔa anyi didi la dzudzɔ zi ɖeka alo wo vɔ: Ƒunukpeƒe alo lãmeka siwo le veve sem, ʋuʋudedi, ɖeɖiteameŋu, taɖuame fafɛ, NYANYA BLIBOE eye MELE ʋuʋum o"| WithdrawalCheck["ACUTE STEROID WITHDRAWAL / EARLY INSUFFICIENCY: 1. Gbugbɔ dze steroid nono gɔme enumake le nuteɖeamedzi ƒe agbɔsɔsɔme nu (10 va ɖo 20 mg Prednisone alo 40 mg Hydrocortisone PO) 2. Di atikewɔlawo ƒe dodokpɔ kpata le ŋkeke ɖeka dzi (alo ƒo ka na 911/112/999 ne taɖuame ne èle tsitrenu) 3. Ne ʋuɖɔɖɔ dze egɔme le teƒe aɖe la, do IM Hydrocortisone mg 100 ɖe lãme na ame eye nàyɔ dɔnɔdzikpɔʋu"]

    TriggerCheck -->|"Dɔléle Sesẽ si Dzɔna le Ɣeyiɣi Dome (Asrã, Dzamezã, Dɔlékuiwo, Dɔwɔwɔ Sue): Nyɔ ŋu, nàna tsiwo naɖiɖi"| VomitOnce{"Ðe dɔnɔa ƒo ʋu ZI ÐEKA le aɖabaƒoƒo 30 me tso esime wòmi woƒe steroid si wonoa?"}

    VomitOnce -->|"Ẽ: Ʋuʋudedi ɖeka ko"| RepeatOral["No steroid si woano zi eve enumake kple electrolyte tsi suesuesuewo nono. Lala miniti 30: ne ʋuʋudedi dzɔ zi EVELIA la, yi IM Injection + 911 / 112 / 999 dzi enumake"]

    VomitOnce -->|"Ao: Atikekui siwo woano dzi ɖeɖe kpɔtɔ"| SickDayRules["ZÃ DƆLÉLE ŊKEKE NUTEƑEKPƆKPƆ ƑE DOZEDZE ƑE SEWO: - Hydrocortisone nono: Dodokpɔ zi gbɔ zi eve gbesiagbe (40 va ɖo 50 mg/ŋkeke) na dzoxɔxɔ 37.5 C alo esi wu nenema; Etɔ̃ (60 mg/ŋkeke) na dzoxɔxɔ 39.0 C alo esi wu nenema, woamae gaƒoƒo 6 ɖesiaɖe gaƒoƒo bliboa katã - Prednisone/Prednisolone nono le 10 mg/ŋkeke ɖesiaɖe te: Dzidzi ɖe edzi va ɖo 10 mg va ɖo 15 mg katã gbesiagbe (womae ɖe 5 mg me gaƒoƒo 12 ɖesiaɖe) - Prednisone nono 10 mg/ŋkeke alo esi wu nenema: Lé gbesiagbe agbɔsɔsɔme me ɖe asi (womae gaƒoƒo 12 ɖesiaɖe ne dzoxɔxɔ) eye nàlé ŋku ɖe ʋuɖɔɖɔ ŋu nyuie"]

Dɔlélenutsiŋutete: Nusitae ne wodzudzɔ steroid siwo nɔa anyi didi alo dzamezã la hea dzidziƒoame si wua ame vɛ¶

1. Alesi Steroid Siwo Woŋlɔ na Amewo Tsia Hypothalamic-Pituitary-Adrenal (HPA) Axis la nu¶

Le ŋutilã si le lãmesẽ me me la, Hypothalamic-Pituitary-Adrenal (HPA) axis ye kpɔa cortisol ƒe agbɔsɔsɔ dzi: 1. hypothalamus la ɖea Corticotropin-Releasing Hormone (CRH) ɖa. 2. CRH doa ŋusẽ ŋgɔgbe pituitary gland be wòaɖe Adrenocorticotropic Hormone (ACTH) ɖa. 3. ACTH zɔa mɔ yia adrenal cortex, si dea se na adrenal glands be woaɖe dzɔdzɔme cortisol miligram 15 va ɖo 25 gbesiagbe le ɖiɖiɖemeɣi, eye wòdzina ɖe edzi va ɖoa milligram 100 va ɖo 300 gbesiagbe le dɔléle sesẽ, dzoxɔxɔ sesẽ, nuveviwɔame, alo amekoko me.

Ne dɔnɔ aɖe no glucocorticoids siwo dona tso gota, abe prednisone (5 mg/ŋkeke alo esi wu nenema), prednisolone (5 mg/ŋkeke alo esi wu nenema), methylprednisolone (4 mg/ŋkeke alo esi wu nenema), alo dexamethasone (0.5 va ɖo 0.75 mg/ŋkeke alo esi wu nenema), wu kwasiɖa 2 va ɖo 4 tsiã ɖe enu (alo exɔa ƒunukpeƒetetedɔ si wogbugbɔna atike siwo wodona ɖe lãme, corticosteroid siwo wogbɔna le agbɔsɔsɔ gã me abe fluticasone, clobetasol krem sesẽ siwo wotsɔna ƒoa ƒui, alo megestrol acetate), hypothalamus kple pituitary sea steroid ƒe dɔwɔwɔ si le ʋu me ƒe dɔwɔwɔ gã kple tɔ te CRH kple ACTH wɔwɔ.

Ne womewɔ ACTH ƒe dzodzo gbesiagbe o la, lãmenugbagbevi siwo wɔa cortisol le adrenal cortex me ɖea wo dzi kpɔtɔna eye woƒe lãme vuna. Ne woɖe steroid si woŋlɔ na ame dzi kpɔtɔ alo wodzudzɔ gɔ̃ hã la, ate ŋu axɔ kwasiɖawo, ɣletiwo, alo ƒe ɖeka kple edzivɔ hafi HPA axis si le alɔ̃ dɔm kple adrenal cortex si vuvu la nagakpɔ ŋutete be wòadzi stress cortisol surge ɖe edzi.

2. Mɔ Eve Siwo Nàto Adrenal Xaxa si Steroid Hena Me¶

Gbesiagbe nɔnɔme eve nana kuxi aɖe si ate ŋu ade ame ƒe agbe afɔku me la dzɔna kabakaba:

• Nɔnɔme A: Steroid Dzudzɔ Kpata alo Agbɔsɔsɔme Si Wobu ("Steroid Ƒe Asiɖeɖe le Nu Ŋu ƒe Afɔku"):
• Dɔnɔ si noa prednisone alo dexamethasone gbesiagbe la ƒe agba siwo wogbugbɔ dea eme vɔna, agbawo buna ne ele mɔ zɔm, dzudzɔa atikekuiwo nono, alo woxɔe ɖe kɔdzi afisi woɖea woƒe aƒeme steroid ɖa le dɔnɔdzikpɔƒewo ƒe nɔnɔmetata me.
• Le gaƒoƒo 12 va ɖo 48 me ne steroid si wowɔ la kɔ ʋua ŋu vɔ la, glucocorticoid ƒe dɔwɔwɔ bliboa ɖiɖina va ɖoa zero, si wɔnɛ be ŋutilãa gena ɖe cortisol dɔwuame sesẽ me.
• Nɔnɔme B: Do kpo Steroids Dzidziɖedzi Le Ŋutilã ƒe Nuteɖeamedzi Me ("Relative Adrenal Crisis"):
• Dɔnɔa noa woƒe atike si wozãna le gɔmedzedzea me (prednisone mg 5 alo hydrocortisone mg 15 va ɖo 20 gbesiagbe), OR mia woƒe ŋditike eye wòɖenɛ le aɖabaƒoƒo 15 megbe le norovirus, nuɖuɖu me aɖi, alo asrã ta.
• Esi wònye be dzoxɔxɔ sesẽ, dɔlékui ƒe dɔgbo ƒe dɔléle, aklãdɔ, aɖuɖɔtoedɔléle, alo ƒu gbagbã hiã hydrocortisone miligram 50 va ɖo 150 si sɔ gbesiagbe be ʋukawo nate ŋu awɔ nu ɖe ​​adrenaline ŋu ta la, agbɔsɔsɔ si wozãna le gɔmedzedzea me beléle na ʋukawo (alo atikekui si woɖena le lãme na ame) gblẽa cortisol ƒe gbɔdzɔgbɔdzɔ si wua ame ɖi.

3. Nusita Cortisol ƒe Manɔmanɔ Hea Refractory Vasoplegic Shock kple Hypoglycemia vɛ¶

Ne cortisol bu le ŋutilã ƒe nuteɖeamedzi me la, tsi etɔ̃ siwo wua ame la ʋuna le ɣeyiɣi ɖeka me: 1. Catecholamine ƒe Dɔmawɔmawɔ nyuie kple Vasoplegic Shock: Cortisol léa alpha-1 adrenergic receptors ɖe ʋukawo ƒe lãmeka gbadzaa dzi kple beta-1 receptors ɖe dzia dzi. Cortisol manɔmee la, dzɔdzɔme adrenaline kple noradrenaline (kple ICU vasopressor drips gɔ̃ hã) mate ŋu axe ʋukawo o. Ʋukawo ƒe dɔlélenutsiŋutete si le ɖoɖo nu la mu eye ʋu ƒe sisi ɖiɖina ɖe anyi wu 80/50 mmHg va zua refractory vasoplegic shock. 2. Aklã me Gluconeogenesis ƒe kpododonu (Severe Hypoglycemia): Cortisol ʋãa aklã be wòatrɔ amino acid kple glycerol wòazu sukli. Ne cortisol bu (vevietɔ le ʋuʋudedi kple nutsitsidɔ me) la, aklã me glycogen ƒuƒlu eye sukli si le ʋu me dzi ɖena kpɔtɔna wu 3.0 mmol/L (54 mg/dL), si wɔnɛ be ame tɔtɔna, ame nɔa alɔ̃ me, eye wòtsia dzodzodzoe. 3. Unchecked Cytokine Storm and Hyponatremia: Ne cortisol ƒe brek mele inflammatory cytokines ŋu o la, dɔnɔa xɔa dzoxɔxɔ sesẽ, myalgias sesẽ, ƒodo me vevesese si srɔ̃a peritonitis, kple non-osmotic release of antidiuretic hormone (ADH), si hea acute dilutional hyponatremia (ʋu me sodium si mebɔ o) vɛ. (To vovo na Addison ƒe dɔléle gbãtɔ, afisi aldosterone hã buna le eye wòhea hyperkalemia vɛ la, dɔnɔ siwo ŋu steroid-si na tertiary adrenal insufficiency le la léa aldosterone ƒe dɔwɔwɔ si me gblẽ o, eyata zi geɖe la, potassium ya sɔna esime sodium kple glucose ɖiɖina le mɔ si me afɔku le nu.)

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Corticosteroid ƒe ŋusẽ kple HPA-axis ƒe nutete ƒe tɔtrɔ ƒe kplɔ̃¶

Zã kplɔ̃ sia si sɔ kple wo nɔewo (si sɔ kple 2024 Endocrine Society / European Society of Endocrinology Joint Guideline) nàtsɔ adzidze afɔku si le adrenal ƒe teteɖeanyi dzi:

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Vovototodede Steroid Withdrawal Syndrome kple Adrenal Crisis Nyateƒetɔ dome¶

Ne dɔnɔ si le steroid siwo wozãna ɣeyiɣi didi ƒe agbɔsɔsɔ gã zãm la ƒe agbɔsɔsɔme dzi ɖe kpɔtɔ alo wodzudzɔ la, ate ŋu ase le eɖokui me be yeƒe dzi medzɔ o ne yewoƒe cortisol ƒe agbɔsɔsɔ sɔ gbɔ gɔ̃ hã (Glucocorticoid Withdrawal Syndrome), alo woate ŋu anɔ gegem ɖe Adrenal Crisis si ate ŋu ade eƒe agbe afɔku me. Alesi atikewɔlawo kple ƒomewo na woto vovoe nye esi:

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Afɔɖeɖe ɖesiaɖe ƒe mɔfiame: Alesi woawɔ Solu-Cortef Act-O-Vial (100 mg / 2 mL) ŋudɔ ahadoe ɖe lãme na ame¶

Ele be dɔnɔ ɖesiaɖe si wonya be eƒe adrenal insufficiency gbãtɔ, evelia, alo esi me afɔku le ŋutɔ si steroid hena vɛ la natsɔ Adrenal Crisis Emergency Injection Kit ɖe asi. Le Dziehe Amerika, Australia, kple Europa ƒe akpa gãtɔ la, mɔ̃ si wozãna ɖaa enye Solu-Cortef Act-O-Vial (100 mg hydrocortisone sodium succinate), si nye ahuhɔ̃e me aŋetu ɖeka si woma ɖe xɔ si me tsi mele o si le etame (tsi si me dɔlékui mele o mL 2) kple xɔ si me wodea aŋɔ ɣi si le ete si me wotsɔ rababa titina ƒe nutrenu ma.

1. Hydrocortisone ƒe agbɔsɔsɔme si wozãna le lãmekawo me si wotu ɖe ƒexɔxɔ dzi¶

Hafi nàwɔ atikeawo la, ɖo kpe agbɔsɔsɔme si tututu dɔnɔa xɔ dzi (ewɔ ɖeka kple UK Society for Endocrinology, BSPED, NICE NG243, kple United States Endocrine Society ƒe mɔfiamewo):

• Ame tsitsiwo kple Ƒewuivi siwo xɔ ƒe 12 kple edzivɔ: miligram 100 = Do Act-O-Vial si wotsaka 2.0 mL bliboa (alo UK tsi ampoule 1.0 mL bliboa si wotsaka do ŋgɔ). Zã 21G va ɖo 23G ƒe aŋe, si didi milimeta 25 va ɖo 38 (inch 1 va ɖo 1.5).
• Ðevi siwo xɔ tso ƒe 1 va ɖo ƒe 11: miligram 50 = Do 1.0 mL (Act-O-Vial si wotsɔ tsaka 2.0 mL ƒe afã, alo 0.5 mL si nye 100 mg / 1 mL ampoule). Zã 23G va ɖo 25G ƒe aŋe, si ƒe didime nye milimeta 16 va ɖo 25 (⅝ va ɖo 1 inch).
• Vidzĩ siwo mexɔ ƒe 1 haɖe o: miligram 25 = Do 0.5 mL (Act-O-Vial si wotsaka ƒe 2.0 mL ƒe akpa enelia, alo 0.25 mL si nye 100 mg / 1 mL ampoule). Zã 25G aŋe, si ƒe didime nye milimeta 16 (inch ⅝).

2. Afɔɖeɖe Enyi Solu-Cortef Se-O-Vial Dɔwɔwɔ kple Gome-Akɔta Dodo ƒe Ðoɖo¶

1. Tsɔ Solu-Cortef Act-O-Vial la da ɖe kplɔ̃ gbadza dzi le tsitrenu.
2. Tsɔ wò asibidɛ ƒe afɔkpodzi te plastic activator ƒe nutrenu si le etame la dzi tẽe. Titina rababa ƒe nutrenu la gena ɖe etexɔa me, eye wòɖea tsi 2 mL si me dɔlékui mele o la dona ɖe hydrocortisone ɣia me.
3. Ʋu aŋetu la blewuu eye nàtrɔe sɛkɛnd 10 va ɖo 15 vaseɖe esime tsi si le eme la nakɔ. Mègaʋuʋui sesĩe o.
4. Trɔ aŋe goglo sue si le etame ƒe nutrenu titina la ɖa. Tsɔ aha sesẽ tutu rababa ƒe nutrenu si woɖe ɖe go la zi ɖeka ne ele asiwò.
5. Ðe atikekui la kple aŋe si wotsɔ blae la, he nutsyɔnu la ɖa tẽ, eye nàhe ya 1.5 va ɖo 2 mL ɖe atikekui la me.
6. Tu aŋea tẽ to rababa bullseye titina eye nàde ya la ɖe goa me.
7. Trɔ atikekui kple atikekui si do ƒome kplii la ɖe anyigba le ŋku ƒe sɔsɔme. Na aŋea ƒe nugbɔ nanyrɔ ɖe tsi ka la te eye nàhe plunger la tẽe va ɖo 2.0 mL ƒe dzesi na ame tsitsi/ƒewuivi (1.0 mL na ɖevi si xɔ tso ƒe 1 va ɖo ƒe 11; 0.5 mL na vidzĩ).
8. Zi ʋuƒoa dzi ale be ya kotoku gã ɖesiaɖe nado ɖe dzi, tu plunger la vie vaseɖe esime tsi aɖe naƒo ɖe eƒe nugbɔ, eye nàhe aŋea ado goe. Micro-bubbles suewo mewɔa nuvevi ame le lãmekawo me dodo me o.
9. Tsɔ aŋea le dzogoe 90 dzi yi ata ƒe titina ƒe akpa etɔ̃lia si le gota (vastus lateralis) eye nàtu plunger la ɖe anyi madzudzɔmadzudzɔe le sɛkɛnd 3 va ɖo 5 me. Keke ŋutigbalẽa sesĩe, tu aŋea ɖe eme tẽ le dzidzenu 90 me evɔ màgbɔe o, doe ɖe eme nyuie, lala sɛkɛnd 2, ɖe aŋea ɖa, eye nàzi teƒea blewuu kple gauze si wotsɔna ƒoa gae.

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"Dɔléle-Ŋkeke ƒe Sewo" bibi na dɔnɔ siwo le Prednisone, Prednisolone, alo Hydrocortisone si nɔa anyi didi zãm¶

Woate ŋu axe mɔ ɖe adrenal ƒe kuxi siwo wu 50 le alafa me nu hafi dzidzi nadzɔ gbeɖe ne wozã Nu me Dɔléle Ŋkeke ƒe Nuteɖeamedzi-Agbɔsɔsɔme Sewo zazã le ɣeyiɣi si me dɔnɔ si zãa steroid xɔ asrã, dɔlékui, ʋuʋudedi, alo abi (le 2024 NICE NG243 kple UK Society for Endocrinology / Endocrine Society ƒe ɖoɖowo nu):

1. Na dɔnɔ siwo zãa Hydrocortisone si wotsɔ ɖɔlia ŋutilã ƒe dɔwɔwɔ (zi geɖe la, 15 va ɖo 25 mg/ŋkeke):
2. Dɔléle si sɔ alo Dzoxɔxɔ 37.5 degree Celsius (99.5 degrees Fahrenheit) alo esi wu nenema (dzamezã, akɔtadɔ, aɖuɖɔtoedɔléle): ÐE wò gbesiagbe hydrocortisone ƒe agbɔsɔsɔ bliboa zi gbɔ zi eve (va ɖo 40 mg/ŋkeke ya teti**, le kpɔɖeŋu me, 20 mg enumake ne dɔlélea dzi ɖe edzi alo wòdze egɔme, emegbe 10 mg gaƒoƒo 6 ɖesiaɖe gaƒoƒo bliboa katã, si me ɣlidodo le zã ɖeka me ale be cortisol naɖiɖi va ɖo zero gbeɖe le ŋdi ga 4:00 me hã le eme).
3. Asrã sesẽ 39.0 degree Celsius (102.2 degrees Fahrenheit) alo esi wu nenema: ÐE wò gbesiagbe hydrocortisone ƒe agbɔsɔsɔme zi gbɔ zi etɔ̃ (va ɖo 60 mg/ŋkeke, nono abe 15 va ɖo 20 mg ene gaƒoƒo 6 ɖesiaɖe zã kple keli) eye nàdi atikewɔlawo ƒe dodokpɔ.
4. Na dɔnɔ siwo noa Prednisone alo Prednisolone si nɔa anyi didi ɖe dɔdzẽ, dɔlélenutsiŋutete, alo gbɔgbɔtsixe ƒe nɔnɔme aɖe ta:
5. Ne wò gbesiagbe agbɔsɔsɔme si nèzãna zi geɖe la MEDE 10 mg/ŋkeke o (le kpɔɖeŋu me, prednisone/prednisolone mg 3, mg 5, alo mg 7.5 nono zi ɖeka ŋdi sia ŋdi): Le dɔléle sesẽ aɖe si me dzoxɔxɔ le me la, dzi wò gbesiagbe agbɔsɔsɔme bliboa ɖe edzi va ɖo 10 va ɖo 15 mg gbesiagbe, eye anyo wu be nàmae ɖe 5 mg le ŋdi me eye 5 mg va ɖo 10 mg le fiẽ me (gaƒoƒo 12 ɖesiaɖe) ale be wò ŋutilã naxɔ gaƒoƒo 24 ƒe glucocorticoid le zã me.
6. Ne wò gbesiagbe agbɔsɔsɔme si nèzãna zi geɖe nye mg 10 va ɖo 20 mg/ŋkeke alo esi wu nenema xoxo: Esi wònye be prednisone mg 10 va ɖo 15 sɔ kple hydrocortisone si ƒe agbɔsɔsɔme le nuteɖeamedzi me ƒe mg 40 va ɖo 60 xoxo ta la, zi geɖe la, mehiã be mehiã be nàzã agbɔsɔsɔme si wozãna le gɔmedzedzea me zi gbɔ zi eve na dzoxɔxɔ bɔbɔe o: ɖeko ma wò gbesiagbe agbɔsɔsɔme si nèzãna xoxo la ɖe eve siwo sɔ kple gaƒoƒo 12 me agbɔsɔsɔmewo (ŋdi kple fiẽ) ale be nutsyɔtsyɔ nagavuvu le zã ɖeka me o, eye mègadzo le agbɔsɔsɔme aɖeke dzi gbeɖe o.
7. Xexeame Katã ƒe Aɖuɖɔtoe kple Aɖuɖɔtoe ƒe Se (Ewɔa dɔ na Steroid ƒe Agbɔsɔsɔme KATÃ):
8. Ne dɔnɔ aɖe no prednisone si wonona mg 40 ŋdi sia ŋdi gɔ̃ hã la, ne eɖe woƒe atikekui la ɖe dzi la, woƒe agbɔsɔsɔme si woxɔna la nye ZERO.
9. Aɖuɖɔtoe Ðeka ƒe Se: Ne èɖe aɖuɖɔ zi ɖeka le miniti 30 va ɖo 60 me tso esime nèmi wò steroid-tike la, lala miniti 15, no tsi vi aɖe, eye nàmi agbɔsɔsɔme si woano zi gbɔ zi eve (e.g., prednisone mg 10 va ɖo 20 alo hydrocortisone mg 20).
10. Aɖuɖɔtoe Evelia alo Aɖuɖɔtoe Sesẽ: Ne èɖe aɖuɖɔ zi evelia, màte ŋu ana tsi nono naɖiɖi o, alo aɖuɖɔtoe si me tsi le le ŋuwò la, atikekui siwo woano mawɔ dɔ o: do 100 mg intramuscular hydrocortisone ɖe gotagome ata me enumake eye nàyɔ 911 / 112 / 999 be woava kɔdzi steroid kple saline si wodona ɖe ʋuka me xɔname.

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Nutome ƒe xexlẽdzesi siwo ku ɖe nudzɔdzɔ kpatawo ŋu kple dɔwɔƒea ƒe ɖoɖowo¶

• United States kple Canada: Ƒo ka na 911 enumake ne èsusu be adrenal crisis le ŋuwò. Asi kpekpeɖeŋunalawo dɔnɔa ƒe Endocrine Society alo National Adrenal Diseases Foundation (NADF) Emergency Protocol Letter, si fia mɔ EMS be wòana 100 mg IV/IM hydrocortisone (alo methylprednisolone/dexamethasone ne steroid mawo koe le dɔnɔdzikpɔʋua me) kple 1,000 mL (lita 1) si woatsɔ ade ʋuka me enumake 0.9% normal saline (alo D5NS ne suklidɔ le lãme na ame).
• United Kingdom: Ƒo ka na 999 eye nàgblɔ na dɔnɔdzikpɔʋu ƒe kaƒoƒodzikpɔla be "Red Flag Adrenal Crisis: Patient holds an NHS Steroid Emergency Card." Le Dukɔa ƒe Dɔnɔwo ƒe Dedienɔnɔ Ŋuti Nuxlɔ̃ame si NHS England, Royal College of Physicians, kple Society for Endocrinology na la te la, dɔnɔ ɖesiaɖe si le steroid si wozãna ɣeyiɣi didi alo esi ƒe agbɔsɔsɔme sɔ gbɔ (including corticosteroids siwo wogbɔna ƒe agbɔsɔsɔ gã) tsɔa NHS Steroid Emergency Card dzĩ (alo BSPED ɖeviwo ƒe agbalẽvi blɔ) si bia be woatsɔ dɔnɔdzikpɔʋu aɖo nɔƒe gbãtɔ enumake, 100 mg IM/IV hydrocortisone, kple 1,000 mL IV 0.9% sodium chloride le miniti 30 me tso esime wotsoe.
• European Union: Ƒo ka na 112 le EU-dukɔwo katã me eye nàtsɔ gbe eve me European Steroid Emergency Card (si dzi Europa Habɔbɔ si Kpɔa Dɔlékuiwo ƒe Dɔlélewo Gbɔ da asi ɖo), si dzi woɖe mɔfiame kpata siwo woɖo ɖe ɖoɖo nu le nutoa me gbe me fiana le akpa ɖeka eye Eŋlisigbe le megbekpa dzi la afia.
• Australia kple New Zealand: Ƒo ka na 000 le Australia alo 111 le New Zealand. Tsɔ Australia ƒe Adrenal Insufficiency / Addison ƒe Dɔléle ƒe Kpata ƒe Kpekpeɖeŋugbalẽvi; dukɔa ƒe dɔnɔdzikpɔƒewo tsɔa hydrocortisone si wodona ɖe lãme na ame eye wowɔna ɖe Endocrine Society of Australia (ESA) ƒe ɖoɖowo dzi.
• India kple Asia-Pacific: Ƒo 112 le India, 995 le Singapore, 119 le Japan kple South Korea, alo 999 le Hong Kong kple Malaysia. Bia Agbenɔƒe Kpekpeɖeŋunadɔ Deŋgɔ (ALS) ƒe dɔnɔdzikpɔʋu eye nàtsɔ dɔnɔa ƒe Solu-Cortef-go ƒuƒlu kple steroid-tikewo ƒe ŋkɔwo ava dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ.

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Nya siwo wobiaa amewo enuenu¶

Ɣeyiɣi didi kae wòle be nàno prednisone alo steroid bubuwo hafi edzudzɔ kpata nazu afɔku?¶

Le ƒe 2024 ƒe Joint Clinical Practice Guideline si tso Endocrine Society kple European Society of Endocrinology gbɔ nu la, ƒã hafi wonoa corticosteroids si woano kpuie si wogbãna si mede kwasiɖa 2 va ɖo 3 o (abe prednisone nono ŋkeke 5 va ɖo ŋkeke 10 na asrã sesẽ alo poison ivy ene) ƒã hafi wòhea adrenal insufficiency si nɔa anyi ɖaa vɛ, eye esiwo le kpuie zi geɖe la, woate ŋu atɔ te nusɔsrɔ̃awo evɔ womaɖe wo dzi akpɔtɔ o. Gake ele be amesiame si noa prednisone alo prednisolone si noa miligram 5 gbesiagbe alo esi wu nenema (alo dexamethasone si ƒe agbɔsɔsɔme nye 0.5 mg/ŋkeke alo esi wu nenema) hena kwasiɖa 3 va ɖo 4 kple edzivɔ tsiã ɖe enu, alo noa atikeawo enuenu le ƒe bliboa me la, natsɔe be wotsi yewoƒe hypothalamic-pituitary-adrenal (HPA) axis nu eye mele be woadzudzɔ yewoƒe steroid zazã gbeɖe o kpata alo woayi steroid siwo wozãna le nuteɖeamedzi me manɔmee le ʋuʋudedi alo dɔléle sesẽ aɖe me.

Nukatae nye ɖɔkta gblɔ nam be mamã nye ŋdi prednisone ɖe ŋdi kple fiẽ ƒe agbɔsɔsɔ me ne asrã sesẽ aɖe le ŋunye?¶

Togbɔ be prednisone kple prednisolone nye steroid siwo wɔa dɔ le domedome eye woƒe dɔlékuiwutikewo nɔa anyi gaƒoƒo 12 va ɖo 36 hã la, woƒe ʋu me agbɔsɔsɔ si sɔ gbɔ wu la dzɔna le gaƒoƒo 1 va ɖo 2 le ŋdi me atikekui nono vɔ megbe eye wòɖiɖina ŋutɔ le ŋufɔke ƒe gaƒoƒo gbãtɔwo me (le zãtitina kple ŋdi ga 6:00 dome). Le dzoxɔxɔ alo dɔlékui sesẽɣi la, wò ŋutilã hiãa glucocorticoid xɔla ƒe kpekpeɖeŋu gaƒoƒo 24 ɣesiaɣi be ʋu ƒe sisi nanɔ te; wò gbesiagbe agbɔsɔsɔme si nètrɔ asi le le nuteɖeamedzi ta mamã ɖe gaƒoƒo 12 ƒe agbɔsɔsɔme eve (ŋdi kple fiẽ) me xea mɔ na cortisol ƒe tsi si me afɔku le zã bliboa.

Ne menoa prednisone mg 15 alo mg 20 gbesiagbe xoxo na ƒunukpeƒetetedɔ alo lupus la, nukatae mate ŋu axɔ adrenal crisis kokoko ne mexɔ dɔgbo me dzamezã?¶

Togbɔ be prednisone nono mg 15 alo mg 20 gbesiagbe naa steroid si nuteɖeamedzi sɔ gbɔ ɖo ne woxɔe hã la, dɔgbo ƒe dɔléle sesẽ (dɔgbomedɔléle) si me ʋuʋudedi alo aɖuɖɔtoe si me tsi le kabakaba le xea mɔ na atikekui la be wòagaʋuʋu ahaxɔe to wò dɔgbo me o. Le ɣeyiɣi si tututu me wò adrenal glands siwo vuvu la mate ŋu awɔ dzɔdzɔme cortisol aɖeke o eye wò ŋutilã le tsi lita geɖe bu ge le ʋu me tso ʋuʋudedi me la, wò ʋu me steroid ƒe agbɔsɔsɔ si woxɔ la ɖiɖina va ɖoa zero, si tae dɔnɔ ɖesiaɖe si nɔa te ɖe steroid dzi si mate ŋu ana atikekui kple tsi siwo woano naɖiɖi o la hiã be woado hydrocortisone mg 100 ɖe lãmeka me enumake eye woado saline ɖe ʋuka me le kɔdzi ɖo.

Aleke mawɔ amimi Solu-Cortef Act-O-Vial ahatsakae evɔ nyemagbã glass la alo tsi si le eme mabu o?¶

Ðo Solu-Cortef Act-O-Vial la gbadzaa ɖe kplɔ̃ sesẽ aɖe dzi eye nàtsɔ wò asibidɛ ƒe afɔkpodzi azi aŋekotoku si le etame la dzi sesĩe vaseɖe esime rababa-mamãnu si le eme la nado ɖe anyi ɖe ahuhɔ̃exɔ si le ete la me. Tsɔ aŋetu la ƒo xlãe blewuu eye nàmlɔe sɛkɛnd 10 va ɖo 15 vaseɖe esime aŋe ɣia nalɔ keŋkeŋ wòazu tsi si me kɔ, trɔ titina plastic ƒe gotagome sue si le nutsyɔnu la tame, do ya mL 2 tso wò syringe me to rababa bullseye la me, trɔ aŋetu la ɖe anyigba le ŋku ƒe sɔsɔme kple aŋea ƒe nugbɔ si le tsi ƒe fli te, eye nàhe mL 2 (100 mg) bliboa ɖe megbe hena ɖeka ame tsitsiwo ƒe ata dodo.

Ðe steroid-tike siwo wodona fũu na asrã alo akɔtave ƒe steroid dodo ate ŋu ahe adrenal-kuxi vɛ nyateƒea?¶

Ɛ̃. Woxɔa corticosteroids siwo wogbɔna ƒe agbɔsɔsɔ gã (vevietɔ fluticasone propionate le agbɔsɔsɔ si wu microgram 500 gbesiagbe le ame tsitsiwo me alo microgram 200 va ɖo 250 gbesiagbe le ɖeviwo me) toa lãkusiwo me tẽ yia ʋuka si me ʋu sina tona me eye aklãa megbãna zi gbãtɔ o, eye triamcinolone alo methylprednisolone dodo ɖe ƒunukpeƒewo ɖea atike si wodona ɖe lãme vivivi steroid hena ɣleti 1 va ɖo 3. Ne dɔnɔ aɖe si le atike siwo wodona fũu zãm la dzudzɔ eƒe yagbɔgbɔ kasia, no atike abe ritonavir alo itraconazole si xea mɔ na steroid ƒe ʋuʋu, alo dɔlékui sesẽ aɖe le eŋu alo wowɔ dɔ nɛ la, ate ŋu axɔ adrenal ƒe kuxi etɔ̃lia si ate ŋu ade eƒe agbe afɔku me eye ele be woatsɔ Steroid Emergency Card ɖe asi.

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Mɔfiame sia naa hehenana nyatakaka kpatawo eye mexɔ ɖe atikewɔwɔ ŋuti aɖaŋuɖoɖo ɖekaɖeka siwo tso wò lãmenugbagbeviwo ƒe dɔwɔwɔ ŋuti nunyala alo atikewɔla si ŋlɔa atike na wò gbɔ teƒe o. Esi wònye be adrenal ƒe kuxi sesẽ ate ŋu ana ʋu ƒe sisi nagbã kabakaba, suklidɔ naɖiɖi kabakaba, eye ame ƒe susu natsi ta la, míele aɖaŋu ɖom vevie be nàwɔ kpekpeɖeŋunadɔ gbãtɔ kple CPR ƒe hehexɔxɔ si ŋu woɖo kpee tso Atitsoga Dzĩ Habɔbɔ, St John Ambulance, alo nutoa me hehenaƒe si ŋu woda asi ɖo gbɔ, eye nàwɔ atike si wodona ɖe lãmekawo me kpata ƒe mɔnu kple wò lãmesẽnyawo gbɔ kpɔha.

Mɔfiame siwo do ƒome kplii¶

• Adrenal ƒe kuxi kple Addison ƒe dɔlélea dodo kpata
• Dzidziƒoame ƒe dzesidede kple kpekpeɖeŋunana gbãtɔwo dzi kpɔkpɔ
• Suklidɔ ƒe nɔnɔme kpatawo: suklidɔ ƒe ɖiɖi kple DKA ƒe kpekpeɖeŋunadɔ gbãtɔ
• Sepsis kple septic shock ƒe dzesidede
• Nuɖuɖu me aɖi, dɔgbo ƒe dɔléle sesẽ, kple tsikuɖiɖi

Dzɔtsoƒewo kple dziɖuɖumegãwo ƒe mɔfiame¶

• Endocrine Habɔbɔ (United States) kple Europa Habɔbɔ si Kpɔa Dɔlékuiwo ƒe Dɔlélewo Gbɔ (ESE): Dɔwɔƒe ƒe Mɔfiame si Wowɔ Ðekae le Glucocorticoid-si Hea Adrenal Insufficiency Didi Kple Edada Ŋu (Beuschlein et al., Journal of Clinical Endocrinology & Metabolism / European Journal of Endocrinology, 2024).
• Dukɔa ƒe Lãmesẽ Kple Belélename Ŋuti Nusrɔ̃ƒe (NICE, United Kingdom): Adrenal Insufficiency: De dzesii kple edzikpɔkpɔ: NICE Mɔfiame NG243 (2024): Dɔnɔŋkeke ƒe sewo, hydrocortisone ƒe atike siwo wozãna kpata le lãmekawo me, kple dɔwɔwɔ vɔ megbe/dɔléle ƒe nuteɖeamedzi ƒe agbɔsɔsɔme na adrenal insufficiency gbãtɔ, evelia, kple etɔ̃lia.
• Society for Endocrinology (United Kingdom) kple Royal College of Physicians (United Kingdom): Dukɔa ƒe Dɔnɔwo ƒe Dedienɔnɔ Ŋuti Nuxlɔ̃ame: Steroid Kpata ƒe Kpekpeɖeŋugbalẽvi si woatsɔ ado alɔ ame tsitsiwo ƒe adrenal ƒe kuxiwo kpɔkpɔ kaba kple wo dada kple Adrenal ƒe dɔmawɔmawɔ nyuie sesẽwo gbɔ kpɔkpɔ kpata.
• British Society for Pediatric Endocrinology and Diabetes (BSPED, United Kingdom): Mɔfiame si dzi woda asi ɖo le Adrenal Insufficiency dzi kpɔkpɔ le Ðeviwo kple Sɔhɛwo me.
• Dukɔa ƒe Adrenal Dɔlélewo Ŋuti Habɔbɔ (NADF, United States) kple Addison ƒe Dɔléle ƒe Kpekpeɖeŋunana Ðokuisi Ƒuƒoƒo (ADSHG, United Kingdom): Afɔɖeɖe ɖesiaɖe Dɔnɔwo Kple Dɔnɔdzikpɔlawo ƒe Mɔfiamewo na Solu-Cortef Act-O-Vial Actuation kple Do Ŋgɔ Na Kɔdzi EMS Taʋiʋli.