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Inkinga ye-Adrenal kanye nomjovo ophuthumayo we-hydrocortisone

Izinombolo zezimo eziphuthumayo ziyehluka ngezwe. Leli khasi lisebenzisa u-911, inombolo yase-United States naseCanada. Amanye amazwe amaningi asebenzisa u-112, 999, noma enye inombolo. Thola inombolo yezwe lakini.

I-adrenal crisis (i-acute adrenal insufficiency) iyisimo esiphuthumayo se-endocrine esibucayi ngesikhathi lapho amazinga omzimba e-cortisol ehla kakhulu kangangokuthi umfutho wegazi wehla, ushukela wegazi wehla, kanye nokushaqeka okubulalayo kokujikeleza kwegazi kwenzeka emahoreni ambalwa. Sihlasela abantu abanesifo sika-Addison (ukungasebenzi kahle kwezindlala ze-adrenal), i-congenital adrenal hyperplasia (CAH), ukuphazamiseka kwe-pituitary (ukungasebenzi kahle kwezindlala ze-adrenal), noma iziguli ezithatha imishanguzo yesikhathi eside yama-steroid lapho umzimba wazo ubhekene nokucindezeleka okuzumayo okungokomzimba okunjengokuhlanza, isifo sohudo, imfiva, ukutheleleka, ukuhlukumezeka, noma ukuhlinzwa. Ngenxa yokuthi ukuwohloka kwenhliziyo nemithambo yegazi kwenzeka ngokushesha uma i-cortisol ingashintshwa, ukwelashwa ngokushesha ngomjovo we-intramuscular 100 milligrams we-hydrocortisone (yabantu abadala) kanye nokuthuthwa kwesibhedlela esiphuthumayo ukuze kufakwe usawoti ovuthayo emthanjeni kufanele kwenzeke ngaphandle kokulibala.

Jova i-hydrocortisone kuqala: ayikho ingozi yokudlula umthamo ovela kumthamo owodwa ophuthumayo

Uma umuntu owaziwayo ngokungakwazi ukusebenza kahle kwezindlala ze-adrenal eba buthakathaka kakhulu, abe nesiyezi, adideke, aphaphatheke, noma eqala ukuhlanza noma isifo sohudo, nika umjovo wakhe ophuthumayo we-hydrocortisone ngokushesha, ngisho noma ungaqinisekanga ngamaphesenti angu-100 ukuthi inkinga ye-adrenal. Izazi ze-Endocrinologists emhlabeni wonke (kuhlanganise ne-Endocrine Society e-United States, i-Society for Endocrinology in the United Kingdom, kanye namanethiwekhi e-adrenal adrenal) agcizelela ukuthi idosi eyodwa ephuthumayo ye-100 milligram ye-hydrocortisone iphephe ngokuphelele ngisho noma ingadingeki, kuyilapho ukubambezeleka komjovo "ukulinda futhi ubone" noma ukulinda kuze kube yilapho kufika i-hyperkalemia ephuthumayo egunjini eliphuthumayo futhi livimbele ukushaqeka okuphuthumayo kwesibhedlela. ukuboshwa kwenhliziyo.

Yenza lokhu manje

  1. Shayela inombolo yakho yasendaweni yezimo eziphuthumayo ngokushesha futhi usho ukuthi "Suspected Adrenal Crisis, Needs IV Hydrocortisone and 0.9% Saline." Shayela u-911 e-United States nase-Canada, 112 ngaphesheya kwe-European Union, 999 e-United Kingdom, noma ubone konke izinombolo eziphuthumayo. Tshela i-dispatcher ukuthi isiguli sincike ku-steroid futhi sibhekene nokuntuleka kwe-adrenal acute, njengoba izivumelwano ezijwayelekile ze-ambulensi zingase zingabeki phambili isiguli esiphalazayo ngaphandle uma inkinga ye-adrenal ishiwo ngokucacile.
  2. Lalisa umuntu emhlane wakhe imilenze yakhe iphakanyisiwe, noma eceleni kwakhe uma ehlanza noma equlekile. Ungamvumeli umuntu ophethwe yi-adrenal crisis ame noma ahlale aqonde, njengoba umfutho wegazi ophansi kakhulu (orthostatic hypotension) ungabangela ukuba alahlekelwe ukwazi ngokushesha kanye nokuboshwa kwenhliziyo. Uma bephapheme futhi bengahlanzi, babeke phansi bese uphakamisa imilenze yabo phezulu ngamasentimitha angu-15 kuya kwangu-30 (amayintshi angu-6 kuya kwangu-12) ukuze ubuyisele igazi enhliziyweni; uma zozele, ziqulekile, noma ziphalaza, zigingqe ohlangothini lwazo kwisimo sokululama ukuze zigcine indlela yazo yokuphefumula ivulekile.
  3. Thola i-Emergency Steroid Injection Kit yesiguli bese ubheka I-Steroid Emergency Card yaso. Bheka esikhwameni saso, isikhwama, idrowa eliseduze nombhede, noma ephaketheni lejazi elibomvu ngokugqamile noma eliphuzi I-Adrenal Crisis Emergency Kit equkethe umjovo hydrocortisone (okungaba i-two-chamber **ActAct-Occinate ye-sodiumAct-Occinate ye-sodium I-Solu-Cortef, i-ampoule yoketshezi egcwaliswe ngaphambili ye-hydrocortisone sodium phosphate, noma ibhodlela eliyimpushana eline-ampoule yamanzi eyinyumba ehlukile), izinaliti, namasirinji.
  4. Lungiselela futhi ujove i-hydrocortisone ye-intramuscular ephuthumayo ngokushesha phakathi kwethanga elingaphandle. Lawula umthamo ophuthumayo ojwayelekile kumsipha omkhulu we-vastus lateralis ongaphandle kwengxenye yesithathu yethanga: ama-milligram angu-100 kubantu abadala nentsha eneminyaka engu-12 nangaphezulu (noma ama-milligram angu-50 kuya ku-5 weminyaka engu-2 kwengane engu-1, kanye ne-milligram engu-1 ubudala izinsana ezingaphansi konyaka ongu-1**, kulandela uhlelo lwengane yomuntu siqu lwesenzo sokudlala ngezindlala ze-adrenal). Phusha inaliti iqonde phakathi nge-engeli engu-90 degree bese ucindezela i-plunger kancane.
  5. Hlola ushukela wegazi ku-capillary noma welaphe okusolakala ukuthi ushukela uphansi uma umuntu ekwazi ukugwinya. Ukuntuleka kwe-Cortisol kukhinyabeza ikhono lesibindi lokwenza i-glucose, okuvamise ukuvusa i-hypoglycemia eqinile (ushukela egazini ngaphansi kuka-\(3.9\text{ mmol/L}\) noma \(70\text{ mg/dL}\)), ikakhulukazi ezinganeni. Uma umuntu ephapheme ngokuphelele futhi ekwazi ukugwinya ngokuphepha ngaphandle kokuvala umlomo, nikeza amagremu angu-15 kuya kwangu-20 kashukela ophuzwayo osebenza ngokushesha (njengamamililitha angu-120 kuya kwangu-180 [amagremu angu-4 kuya kwangu-6] ejusi yesithelo noma i-soda evamile engadli ukudla, noma amaphilisi eglucose ama-3 kuya kwangu-4) noma ingxube ye-electrolyte; ungalinge ufake uketshezi noma ukudla emlonyeni womuntu owozelayo, odidekile, noma ohlanzayo.
  6. Gcina umuntu efudumele futhi unikeze abezimo Eziphuthumayo Ikhadi lakhe Lesimo Esiphuthumayo kanye nebhodlela elingenalutho. Mboza isiguli ngengubo yokulala ukuze uvikele i-hypothermia ngesikhathi ulinde usizo lwezokwelapha oluphuthumayo. Lapho abezimo eziphuthumayo befika, banikeze isiguli Ikhadi Lezimo Eziphuthumayo lesiguli (i-NHS Steroid Emergency Card e-United Kingdom, i-NADF Emergency Protocol Letter e-United States, noma i-European Emergency Card) futhi ubatshele isikhathi esiqondile nomthamo womjovo we-hydrocortisone ukuze baqale ngokushesha *1,000 litre 1% yesawolitha evamile kanye ne-continuous milliliter. ukwesekwa kwe-intravenous steroid.

Ukuqashelwa kwenhlekelele ye-Adrenal kanye nesihlahla sesinqumo somjovo ophuthumayo

Sebenzisa leli shidi lokugeleza lomtholampilo ukuze unqume ngemizuzwana nje ukuthi isiguli esithembele ku-steroid sidinga ukuphindwa kabili kwethebhulethi yethebhulethi ethi "Umthetho Wosuku Lokugula" noma umjovo wokuhlenga osheshayo we-intramuscular hydrocortisone.

flowchart TD
    Start["Isiguli esinesifo i-Addison, i-CAH, i-Pituitary Failure,<br/>noma Ukwelapha Nge-Steroid Yesikhathi Eside Kuthuthukisa Ukucindezeleka Okukhulu noma Ukugula"] --> CrisisCheck{"INGABE ZIKHONA Izimpawu Zenkinga Yefulegi Elibomvu Ezikhona?<br/>1. Ukuhlanza okungapheli noma isifo sohudo esinamandla<br/>2. Isiyezi esinzima, ukuquleka, noma isikhumba esiphaphathekile se-clammy<br/>3. Ukudideka, ukukhathala okwedlulele, noma inkulumo engacacile<br/>4. Ubuhlungu obukhulu besisu, ohlangothini, noma umhlane<br/>5. Ukuhlukumezeka okukhulu, ukuphuka, noma ukungaphenduli"}

    CrisisCheck -->|"YEBO: Noma yiluphi uphawu olulodwa olukhona<br/>NOMA alukwazi ukugcina amaphilisi ephansi"| InjectNow["IPROTOCOL I-ADRENAL CRISIS PROTOCOL:<br/>1. Lala phansi (noma indawo yokululama uma uhlanza/uqulekile)<br/>2. Jova i-IM Hydrocortisone phakathi kwethanga elingaphandle MANJE:<br/> - Abantu Abadala Nentsha (iminyaka engu-12+): 100 mg<br/> - Izingane (unyaka o-1 kuye ku-11): 50 mg<br/> - Izingane (<1 unyaka): 25 mg"]

    InjectNow --> CallEMS["Shayela ku-911 / 112 / 999 Ngokushesha:<br/>Isimo 'Inkinga Ye-Adrenal Esongela Impilo'<br/>Cela I-Paramedic IV 0.9% Ejwayelekile Yosawoti + Ezokuthutha Esibhedlela"]

    CallEMS --> GlucoseStep{"Ingabe isiguli siphapheme futhi siyakwazi<br/>ukugwinya ngaphandle kokuhlanza?"}
    GlucoseStep -->|"Yebo"| GiveSugar["Hlola ushukela wegazi uma imitha likhona<br/>Phuza kancane isiphuzo se-electrolyte noma ijusi uma i-hypoglycemic<br/>Qhubeka ulele kuze kufike uhlaka lwe-ambulensi"]
    GlucoseStep -->|"Cha: Ukuphalaza noma ukozela"| AirwayProtect["Ungagcini Lutho Ngomlomo (NPO)<br/>Gcina indawo yokululama ehlangothini futhi uhlale ufudumele<br/>Ikhadi Lesimo Esiphuthumayo Sesandla Se-Steroid kubasebenzi be-EMS"]

    CrisisCheck -->|"CHA: Ukugula okumaphakathi kuya kokumaphakathi kuphela,<br/>uqaphe ngokugcwele, akukho ukuhlanza"| OneVomitCheck{"Ingabe isiguli sike sahlanza KANYE<br/>phakathi nemizuzu engu-30 sithatha i-oral steroid?"}

    OneVomitCheck -->|"Yebo: Ukuhlanza okukodwa kuphela"| RepeatOral["Thatha umthamo we-DOUBLE oral hydrocortisone ngokushesha ngokuphuza amanzi<br/>Linda imizuzu engu-30: uma ukuhlanza kwenzeka LESIBILI,<br/>qhubekela ngokushesha ku-IM Injection + 911 / 112 / 999"]

    OneVomitCheck -->|"Cha: Ukugcina amaphilisi omlomo ephansi"| SickDayRules["Sebenzisa Imithetho Yosuku Lokugula Ngomlomo:<br/>- Fever >= 37.5 C (99.5 F): DOUBLE oral hydrocortisone DOUBLE nsuku zonke<br/>- I-High Fever >= 39.0 C (102.2 F): Idosi yomlomo yansuku zonke KATHATHU<br/>- Sabalalisa imithamo njalo ngamahora ama-4 kuya kwangu-6 (i-electroclyding amahora angu-6) uketshezi; bhekisisa amafulegi abomvu enhlekelele"]

Ukuqonda ukuthi kungani inkinga ye-adrenal ibulala ngokushesha okungaka: i-cortisol ne-aldosterone cascade

Kumuntu onendlala ye-adrenal enempilo, i-adrenal cortex ngokuqhubekayo ikhiqiza i-cortisol (ihomoni ye-glucocorticoid) kanye ne-aldosterone (ihomoni ye-mineralocorticoid). Ngaphansi kwezimo ezivamile zokuphumula, umuntu omdala ophile kahle ukhiqiza cishe amamiligremu angu-15 kuya kwangu-25 e-cortisol ngosuku*. Lapho uhlaselwa umkhuhlane omkhulu, ukutheleleka, ukuhlukumezeka, noma ukuhlanza, indlala ye-pituitary enempilo iyala izindlala ze-adrenal ukuthi zikhiphe ukuphuma kwe-cortisol okuphindwe kathathu ukuya ka-10, kuze kufike kumamiligremu ayi-100 kuye kwangama-300 ngosuku.

Esigulini esinokuntuleka kwe-adrenal, izindlala ze-adrenal azikwazi ukukhiqiza lokhu kuhlinzwa. Ngaphandle uma i-steroid eshintshwayo eyengeziwe inikezwa ngomlomo noma ngomjovo, ukwehluleka okune ngokomzimba kwenzeka ngesikhathi esisodwa:

1. Ukulahlekelwa kwethoni ye-vascular kanye nokungaphenduli kwe-catecholamine (Vasoplegic Shock)

I-Cortisol igcina ukuzwela kwama-alpha-1 kanye ne-beta-1 adrenergic receptors emithanjeni yegazi nasenhliziyo. Ngaphandle kwe-cortisol, i-adrenaline yemvelo (epinephrine) kanye ne-noradrenaline (i-norepinephrine) ayikwazi ukubopha imithambo yegazi. Imithambo yegazi iyanwebeka ngendlela engalawuleki, ukungakwazi ukumelana ne-peripheral kuyagoqa, futhi umfutho wegazi wehla ube yi-refractory vasoplegic shock emelana nokuconsa kwe-vasopressor kuze kukhishwe i-hydrocortisone emthanjeni.

2. Usawoti wezinso omkhulu nokumosha amanzi (Hypovolemic Shock)

Ku Primary Adrenal Insufficiency (Isifo sika-Addison kanye ne-Congenital Adrenal Hyperplasia emosha usawoti), i-adrenal cortex nayo ayinayoaldosterone, etshela izinso ukuthi zigcine isodium namanzi kuyilapho ikhipha i-potassium. Ngaphandle kwe-aldosterone ne-cortisol, izinso zilahla i-sodium namanzi emchamweni. Kuhlanganiswe nokuhlanza noma isifo sohudo, umthamo wegazi ojikelezayo wehla ngamaphesenti ** angu-20 kuya kwangu-30 (amalitha angu-3 kuya kwangu-5 kumuntu omdala)** phakathi namahora, okubangela ukushaqeka kwe-hypovolemic kanye nokulimala okukhulu kwezinso.

3. Ukuphazamiseka kwe-electrolyte okuyingozi: I-Hyponatremia ne-Hyperkalemia

Njengoba i-sodium ilahleka kumchamo kanye ne-antidiuretic hormone (ADH) ikhuphuka, amazinga e-sodium egazini ehla (acute hyponatremia, ngokuvamile abe ngaphansi kuka-\(130\text{ mmol/L}\)), okubangela ukuvuvuka kobuchopho, ukudideka, nokuquleka. Ngesikhathi esifanayo, ekungakwazini kahle kwe-adrenal, i-potassium yegazi ikhuphuka ngaphezu kuka-\(5.5\umbhalo{kuya ku-}7.0\text{ mmol/L}\) (hyperkalemia), ukuqhutshwa kwenhliziyo okunobuthi nokucupha amagagasi aphakeme, i-bradycardia, kanye ne-ventricular fibrillation noma i-asystolic cardiac arrest.

4. Ukwehluleka kwe-hepatic gluconeogenesis (I-Hypoglycemia Enzima)

I-Cortisol iyala isibindi ukuthi sikhiqize ushukela ngama-amino acid kanye ne-glycerol (gluconeogenesis). Lapho i-cortisol inyamalala phakathi nokuzila ukudla noma ukugula, i-glycogen yesibindi ithulula ngokushesha futhi ushukela wegazi wehla ngaphansi kuka-\(3.0\text{ mmol/L}\) (\(54\text{ mg/dL}\)). Ezinsaneni nasezinganeni ezincane ezine-Congenital Adrenal Hyperplasia (CAH) noma i-hypopituitarism, i-neuroglycopenic hypoglycemia ivamise ukuba uphawu lokuqala lwenkinga, evezwa njengokuxhuga, ukungaphenduli, noma ukuquleka.

Ukuqhathanisa izinhlobo ezintathu zokungasebenzi kahle kwe-adrenal

Isici Ukuntuleka Okuyisisekelo Kwe-Adrenal (Isifo sika-Addison & CAH) Ukungasebenzi Kwe-Adrenal yesibili (Ukwehluleka Kwe-Pituitary) Ukungasebenzi Kwe-Adrenal Okuphakeme / Okubangelwa I-Steroid
**Indawo ye-anatomical yokwehluleka ** I-Adrenal cortex uqobo iyabhujiswa noma ivinjwe nge-enzymatic. I-pituitary gland yehluleka ukukhiqiza i-ACTH. I-Hypothalamus ne-pituitary icindezelwe ama-steroids esikhathi eside kadokotela.
Izimbangela ezivamile ezicashile I-Autoimmune adrenalitis (isifo sika-Addison), i-Congenital Adrenal Hyperplasia (ukuntuleka kwe-21-hydroxylase), i-adrenalectomy yamazwe amabili, ukopha kwe-adrenal, isifo sofuba, noma i-checkpoint inhibitor immunotherapy. Amathumba e-pituitary, ukuhlinzwa kwe-pituitary noma ngemisebe, i-Sheehan's syndrome, ukulimala kobuchopho okubuhlungu, noma i-hypophysitis. Ukusetshenziswa kwesikhathi eside (\(>3\text{ to }4\text{ weeks}\)) komlomo i-prednisone, i-prednisolone, i-dexamethasone, i-methylprednisolone, noma umthamo ophezulu we-corticosteroids ehogelwe/umjovo.
I-Cortisol ne-Aldosterone Kokubili ukushoda kwe-cortisol ne-aldosterone (kuthatha nsuku zonke i-hydrocortisone + fludrocortisone). I-Cortisol iyashoda; i-aldosterone igcinwe (ilawulwa uhlelo lwe-renin-angiotensin yezinso). I-Cortisol ibuthuntu; i-aldosterone ilondoloziwe.
Ukubukeka kwesikhumba sakudala I-Hyperpigmentation ("bronzing") yokuphuka kwesikhumba, amaqupha, izibazi, nezinsini ngenxa ye-ACTH ephezulu. Isikhumba esiphaphathekile esihlulekayo ukuba mnyama ngenxa yokuncipha kwe-ACTH. Ngokuvamile kubonisa izici ze-Cushingoid (ubuso obuyindilinga, isikhumba esincanyana) kusukela kuma-steroid okwelapha angaphambili.
Izingozi ezithile zelebhu Ukuphelelwa amanzi kakhulu emanzini, hyponatremia, hyperkalemia, kanye ne-hypoglycemia. Okubi hyponatremia kanye hypoglycemia; potassium evamile. I-hypotension eqinile, i-hyponatremia, kanye nokushaqeka uma ama-steroid emiswa kungazelelwe noma engafakwanga umthamo wokucindezeleka.
Izimo eziphuthumayo ze-IM Hydrocortisone 100 mg IM ngokushesha (50 mg ubudala 1 kuya 11 yrs; 25 mg for \(<1\text{yr}\)). 100 mg IM ngokushesha (50 mg ubudala 1 kuya 11 yrs; 25 mg for \(<1\text{yr}\)). 100 mg IM ngokushesha (50 mg ubudala 1 kuya 11 yrs; 25 mg for \(<1\text{yr}\)).

Ukubona inkinga ye-adrenal ezayo noma esebenzayo: ukuqhubeka kwezimpawu

Buka lezi zimpawu, ikakhulukazi uma zibangelwa i-gastroenteritis (ukuhlanza/uhudo kubala ngaphezu kwamaphesenti angu-50 azo zonke izinkinga ze-adrenal), izifo zomchamo noma zokuphefumula, ukukhishwa kwamazinyo, ukushisa okukhulu, noma ukuhlukumezeka.

Izimpawu zokuxwayisa zangaphambi kwesikhathi (iwindi langaphambi kwenhlekelele: imizuzu kuya emahoreni ambalwa)

  • Ukukhathala okungazelelwe, okumangazayo nobuthakathaka bemisipha: Ubunzima bokuphakamisa ikhanda noma ukuhamba egumbini.
  • Isicanucanu esinamandla, ukungakuthandi ukudla, nokuluma kwesisu: Ngokuvamile kwenziwa iphutha nokungagayeki kalula.
  • Isiyezi se-Postural kanye nekhanda elikhanyayo: Umbono uba mnyama noma nini lapho uhlezi noma umile.
  • Ikhanda elibuhlungu elibuhlungu, ukucasuka, ukungahlaliseki, noma ukudideka: Izimpawu zokuqala zokwehla komfutho wegazi, i-hyponatremia, ne-cortisol yobuchopho ephansi.
  • Imfiva engachazeki noma izinga lokushisa lomzimba elingejwayelekile (ukubanda nokuqhaqhazela): Ukulahlekelwa yi-Cortisol kuphazamisa i-thermoregulation.

Amafulegi abomvu we-adrenal crisis (isimo esiphuthumayo sezempilo esisongela ukuphila)

  • Ukuhlanza okuphindaphindiwe noma isifo sohudo esimanzi: Uma amaphilisi omlomo ehlanzwa, amathumbu awakwazi ukumunca ukushintshwa komlomo, okwenza umjovo we-intramuscular ube yimpoqo.
  • Ubuhlungu obukhulu, obubukhali besisu, iqolo, noma ihlaka/umlenze: Uphawu oluphawulekayo lwenkinga ye-adrenal engalingisa isisu sokuhlinzwa esibuhlungu.
  • Isikhumba esiphaphathekile, esibandayo, esinezimfishane, esinamabala aphuzi esine-capillary refill ebambezelekile (\(>2\text{ seconds}\)).
  • I-Tachycardia kanye ne-hypotension ejulile: Ukushaya kwenhliziyo okubuthakathaka okusheshayo (\(>110\umbhalo{ ukuya }ku-}130\text{ bpm}\)) nomfutho wegazi we-systolic ongaphansi kuka-\(90\text{ mmHg}\).
  • I-Encephalopathy, inkulumo engahlangani, i-stupor, isithuthwane, noma i-coma: Ngokuvamile kwenziwa iphutha njengokudakwa, unhlangothi, noma i-sepsis.

I-Gastroenteritis Trap: Kungani Amaphilisi Omlomo Ehluleka Ngesikhathi Sokuhlanza kanye Nohudo

Ngisho noma isiguli sigwinya umthamo ophindwe kabili noma kathathu wamaphilisi omlomo e-hydrocortisone phakathi nesiphazamisi sesisu, ukuhlanza okunamandla kanye nesifo sohudo esisheshayo esimanzi kuvimbela isisu namathumbu amancane angenhla ekumunceni umuthi egazini. Ngesikhathi esiqondile lapho umzimba udinga izikhathi ezi-3 kuya kwezi-5 izinga le-cortisol elivamile ukuze usinde ekuphelelweni amanzi emzimbeni kanye nokuvuvukala kwamathumbu, i-cortisol ejikelezayo yehla ibe ziro. Umthetho wesithupha: Uma isiguli sihlanza kanye phakathi kwemizuzu engu-30 yokuthatha umthamo we-oral steroid, singase ngokushesha sithathe umthamo owodwa ophindwe kabili womlomo ngokuphuza okuncane kwamanzi; uma behlanza okwesibili, noma benohudo olunamandla oluqhubekayo, ungazami amaphilisi omlomo futhi: nikeza umjovo we-intramuscular hydrocortisone ongu-100 mg ngokushesha bese ushayela ku-911/112/999.

Igayidi yesinyathelo ngesinyathelo: Uyilungiselela futhi uyijove kanjani i-hydrocortisone ye-intramuscular

Izinsiza eziphuthumayo ze-hydrocortisone ziza ngamafomethi amathathu amakhulu kuye ngezwe lakini kanye nokuhlinzekwa kwekhemisi. Ngenxa yokuthi ukudweba umuthi ngezandla ezivevezelayo ngesikhathi sezimo eziphuthumayo kuyacindezela, landela iziqondiso ezingezansi zohlobo lwebhodlela elingaphakathi kwekhithi yesiguli.

Ithebula lereferensi lesilinganiso esiphuthumayo sezingane kanye nabadala

Ngaphambi kokwenza umjovo, qinisekisa umthamo osuselwe eminyakeni yesiguli (othathwe ku-United Kingdom Society for Endocrinology, British Society for Pediatric Endocrinology and Diabetes [BSPED], kanye nemihlahlandlela yokuvumelana ye-United States Endocrine Society):

Iminyaka yesiguli kanye neqembu lesisindo esilinganiselwe I-Emergency Intramuscular Hydrocortisone Dose Ivolumu ezojovwa (uma ixubene nokugxilisana okungu-\(100\text{ mg} / 2\text{ mL}\) [\(50\text{ mg/mL}\)]) Ivolumu yokujova (uma kusetshenziswa i-ampoule egcwele engu-\(100\text{ mg} / 1\text{ mL}\) egcwaliswe kusengaphambili) Usayizi yenaliti onconyiwe wangaphandle maphakathi nethanga (vastus lateralis)
Abadala kanye Nentsha eneminyaka eyi-12 nangaphezulu 100 milligrams Yonke \(2\umbhalo{ mL}\) vial Yonke \(1\umbhalo{ mL}\) ampoule 21G kuya ku-23G, ubude 25 kuya ku-38 amamilimitha (1 kuya ku-1.5 amayintshi) (ihabhu eluhlaza okwesibhakabhaka noma eluhlaza).
Izingane ezineminyaka engu-6 kuya kweyi-11 (noma ubudala besikole samabanga aphansi) 50 milligrams (Qaphela: Ezinye izivumelwano zase-US zisebenzisa u-50 kuya ku-100 mg ngokusekelwe endaweni yomzimba [\(50\text{ ukuya }ku-100\text{ mg/m}^2\)]; landela uhlelo lokunakekela olubhaliwe lwengane) \(1.0\umbhalo{ mL}\) (uhhafu we-\(2\text{ mL}\) isitsha esixutshiwe) \(0.5\umbhalo{ mL}\) (uhhafu we-\(1\text{ mL}\) ampoule) 23G kuya ku-25G, ubude amamilimitha angu-25 (intshi engu-1) (ihabhu eliluhlaza okwesibhakabhaka noma elolintshi).
Izingane ezincane ezineminyaka engu-1 kuya kwemi-5 50 amamiligremu \(1.0\umbhalo{ mL}\) (uhhafu we-\(2\text{ mL}\) isitsha esixutshiwe) \(0.5\umbhalo{ mL}\) (uhhafu we-\(1\text{ mL}\) ampoule) 23G kuya ku-25G, ubude 16 kuya ku-25 amamilimitha (⅝ kuya ku-1 intshi).
Izinsana ezingaphansi konyaka ongu-1 25 milligrams \(0.5\umbhalo{ mL}\) (ikota eyodwa ye-\(2\text{ mL}\) vial exutshiwe) \(0.25\text{ mL}\) (ikota eyodwa ye-\(1\text{ mL}\) ampoule) 25G, ubude 16 amamilimitha (⅝ intshi) (ihabhu eliwolintshi).

Indlela A: Isetshenziswa kanjani i-Act-O-Vial enamagumbi amabili (Solu-Cortef 100 mg / 2 mL)

I-Solu-Cortef Act-O-Vial (i-hydrocortisone sodium succinate) iyisisetshenziswa esiphuthumayo esivame kakhulu e-United States, e-Canada, e-Australia, nasezingxenyeni ezithile ze-Europe. Ibhodlela lengilazi elilodwa elihlukaniswe izingxenye ezimbili ngesivalo serabha esimaphakathi: ingxenye engezansi iphethe impushana ye-hydrocortisone emhlophe, kanti ingxenye engaphezulu ibamba u-\(2\text{milliliters}\) wamanzi oyinyumba.

  1. Geza noma uhlanze izandla zakho uma usheshe, bese usetha ikhithi endaweni eyisicaba. Ungamoshi imizuzu ngokukhuhla uma isiguli siwa; isivinini sibaluleke kakhulu kunokuphelela okuyinyumba.
  2. Cindezela phansi ngokuqinile ikepisi le-activator yepulasitiki phezulu kwebhodlela. Beka ibhodlela liqonde etafuleni eliqinile bese ulisunduza liqonde phansi ngesithende sentende yesandla sakho phezu kwekepisi yepulasitiki ephezulu uze uyizwe icindezela bese ubona isihlukanisi senjoloba esimaphakathi siwela egumbini elingaphansi, sidedela amanzi angenalutho abe yimpushana emhlophe.
  3. nyakazisa futhi uzungezise ibhodlela imizuzwana eyi-10 kuye kweyi-15 kuze kube yilapho uketshezi selucwebile. Unganyakazisi ngamandla (okudala amagwebu amagwebu), vele utshekise futhi ugoqe ibhodlela phakathi kwezandla zakho kuze kube yilapho yonke impushana emhlophe incibilika ngokuphelele.
  4. Phenya ithebhu encane emaphakathi yepulasitiki phezu kwekepisi. Lokhu kuveza indilinga yerabha eyisicaba emaphakathi nekepisi ephezulu. (Uma i-alcohol swab ilungile, sula i-rubber top kanye futhi uyeke yome umzuzwana.)
  5. Namathisela inaliti ngokuqinile kusisirinji, khipha ikepisi yenaliti, bese ubuyisela ipulangwe kumaki angu-2 mL (umoya). Ukubeka u-\(1\text{kuya }2\text{mL}\) yomoya kusipetu kuqala kwenza ukudonsa uketshezi oluphuma ebhodleleni kube lula kakhulu.
  6. Phusha inaliti iqonde phansi phakathi nendawo yendilinga yerabha bese ujova umoya ebhodleleni. Gcina ichopho lonaliti ngaphakathi ebhodleleni.
  7. Phendukisa ibhodlela nesipetu usibhekise phansi (ibhodlela phezulu, isirinji ngaphansi) ezingeni leso. Qinisekisa ukuthi isihloko senaliti sihlala sicwile ngaphansi kwezinga loketshezi ngaphakathi kwentamo yebhodlela ukuze udonse uketshezi, hhayi umoya.
  8. Donsela i-plunger uqonde phansi ukuze ukhiphe umthamo ogcwele. Donsa yonke indlela uye kumaka \(2\text{mL}\) kumuntu omdala/omusha (100 mg), uphawu \(1.0\text{ mL}\) enganeni eno-1 kuya ku-11 (50 mg), noma umaki **\(0.5\nt ngaphansi konyaka ongu-2{mL}\) wombhalo ongu-1*fa $5{mL}
  9. Khipha amabhamuza amakhulu omoya bese ukhipha inaliti ebhodleleni. Njengoba inaliti isabheke ophahleni, phephetha umbhobho wesirinji ngomunwe wakho ukuze noma yimaphi amabhamuza amakhulu omoya akhuphukele phezulu, uphushele ipulangwe phezulu kancane kuze kuvele ubuhlalu obuncane obuwuketshezi esihlokweni senaliti, bese udonsa inaliti uqonde ebhodleleni. (Ungethuki ngamabhamuza amancane alingana ne-champagne; kumjovo wethanga ongaphakathi kwemisipha, amabhamuza amancane awanangozi ngokuphelele.)

Indlela B: Isetshenziswa kanjani i-ampoule yengilazi ewuketshezi exutshwe ngaphambili (Hydrocortisone Sodium Phosphate 100 mg / 1 mL)

Okuvame ukushiwo e-United Kingdom (njenge-Efcortesol noma i-generic hydrocortisone sodium phosphate) kanye nezingxenye ze-Europe, lokhu kuza njengoketshezi osekulungele ukusetshenziswa ngaphakathi kwe-ampoule yentamo yengilazi evalekile, engadingi kuxutshwa.

  1. Thepha intamo engaphezulu ye-ampoule yengilazi ngozipho lwakho. Lokhu kuqinisekisa ukuthi lonke uketshezi lwehlela phansi emzimbeni oyinhloko we-ampoule yengilazi futhi akukho okuvaleleke kukepisi eliphezulu.
  2. Thola ichashazi elinemibala entanyeni ye-ampoule bese ususa ingaphezulu lengilazi kude nechashazi. Bamba iphansi le-ampoule ngesandla esisodwa, ubeke esinye isithupha sakho ngqo phezu kwechashazi elinemibala entanyeni (ukusonga ithishu, iphedi ye-gauze, noma ikhona lehembe lakho phezulu ukuze uvikele iminwe yakho engilazini), bese usunduza* usuke phezulu* uhlanze ingilazi icishiwe.
  3. Faka inaliti enamathiselwe kusirinji sakho ku-ampoule evulekile ngaphandle kokuthinta unqenqema lwengilazi ephukile. Tshekisa i-ampoule kancane uma kudingeka bese udonsela i-plunger emuva ukuze udwebe uketshezi olugcwele lwe-\(1\text{ mL}\) lomuntu omdala (noma u-\(0.5\text{ mL}\) wengane eno-1 kuya ku-11,{0.25)\umbhalo ngo-$0.25). Uma ikhithi yakho ihlanganisa inaliti yokuhlunga yokudweba kusuka engilazini, shintshela enalithi yomjovo e-intramuscular ngaphambi kokujova emlenzeni.
  4. Khomba isirinji phezulu, cindezela umgqomo, bese uphusha i-plunger kancane kuze kuvele iconsi ekugcineni.

Isinyathelo ngesinyathelo: Ukujova phakathi nethanga elingaphandle (vastus lateralis)

Uma isirinji yakho isilayishwe i-hydrocortisone, faka umjovo ku- ngaphandle maphakathi kwesithathu kwethanga ngokushesha:

  1. Thola indawo okuqondiswe kuyo ethangeni. Hlukanisa ithanga lesiguli ngokulibuka lisuka enkambweni yethambo le-hip phezulu ukuya ku-kneecap ezansi libe amabhande amathathu avundlile alinganayo. Ithagethi ephephile iyingxenye yesithathu emaphakathi, ohlangothini olungaphandle (isici esiseceleni) sethanga**. Veza isikhumba uma sishesha, nakuba esimweni esiphuthumayo ungajova ngezingubo ezilula, ezihlanzekile zongqimba olulodwa uma ukususa amabhulukwe aqinile kuzobambezela ukunakekelwa.
  2. Yelula isikhumba sibe sicaba (noma hlanganisa kahle umsipha kumuntu ozacile kakhulu noma enganeni encane). Beka isandla sakho esingalawuleki ethangeni futhi welule i-taut yesikhumba phakathi kwesithupha sakho nomunwe wokukhomba.
  3. Phukula inaliti iqonde phakathi nge-engeli engamadigri angu-90. Bamba umbhobho wesirinji njengomcibisholo phakathi kwesithupha sakho neminwe bese uphusha inaliti ngokushelela nangokuqina uqonde emsipha wethanga nge-engeli 90-degree endaweni yesikhumba, ufake cishe izingxenye ezimbili kwezintathu ubude obugcwele benaliti ukuze isihloko somsipha sihlale sijule. Imihlahlandlela yesimanje esuka ku-World Health Organization, CDC, kanye ne-UK NHS iqinisekisa ukuthi AKUMELE uhlehle/ulangazelele igazi ngaphambi kokujova ethangeni elingemuva ngoba ayikho imithambo yegazi emikhulu egijima kule ndawo.
  4. Phusha i-plunger yehle iye phansi ngokushelela ngaphezu kwamasekhondi angu-3 ukuya kwangu-5. Ukusunduza okuzinzile, okumaphakathi kunciphisa ukuhlaba kwemisipha kuyilapho kungenisa i-steroid kumbhede ocebile we-capillary womsipha wethanga ngokushesha.
  5. Linda imizuzwana emi-2, donsa inaliti iqonde ngqo ku-engeli engama-degree angu-90, bese ucindezela indawo. Cindezela ucezu lwe-gauze, izicubu, noma umunwe wakho ohlanzekile ngokuqinile phezu kwendawo yomjovo imizuzwana eyi-10 ukuya kwangu-20. Ungalihlikihli noma uhlikihle isayithi ngamandla, njengoba ukuhlikihla kungaphoqa umuthi ukuthi ubuyele engqimbeni yamafutha angaphansi kwesikhumba lapho emunca khona kancane.
  6. Yenza inaliti iphephe ngokushesha. Yenza kusebenze isivikelo sokuphepha esinamahenjisi uma usebenzisa inaliti yokuphepha, noma beka isirinji engavaliwe ngokuqondile esitsheni sepulasitiki esiqinile noma ibhokisi elibukhali ukuze wena noma abezimo eziphuthumayo nithole uthi lwenaliti ngephutha.

Enye indlela yokujova engaphansi kwesikhumba (Isipele Esiphuthumayo Esingekho Kulebula)

Umjovo ojwayelekile we-intramuscular emsipha wethanga uyindinganiso yegolide futhi ufinyelela amazinga aphezulu e-cortisol yokwelapha cishe emizuzwini eyi-15 kuye kwengama-30. Kodwa-ke, ukuhlola kwe-pharmacokinetic okwenziwa e-Europe kubonise ukuthi uma isiguli noma umnakekeli enenaliti engaphansi kwesikhumba emfushane kuphela noma engakwazi ukujova umsipha ojulile eyedwa, ejova u-\(100\text{mg}\) we-hydrocortisone subcutaneously egoqweni elimpintshiwe lamafutha esisu afinyelela ku-cortisol evikelekile evikela igazi>L{000}{101}{101}{101}{101}{101}{101}{101}{101}{101}{101}{101}{1011Melika-protection blood cortisol, n00$200/10/10/20/10/10/10, L \(36\text{ mcg/dL}\)) cishe emaminithini angu-22 (uma kuqhathaniswa nemizuzu eyi-11 kuya kweyi-15 nge-intramuscularly). Ungalokothi uvumele ukwesaba umjovo we-intramuscular kukuvimbele ekutholeni i-hydrocortisone ngaphansi kwesikhumba.

Kungani ukuthuthwa esibhedlela kanye ne-IV 0.9% ye-saline evamile kuyimpoqo ngemva komjovo

Umbono oyiphutha ovamile noyingozi ukuthi uma isiguli sesiwutholile umjovo waso we-100 milligram hydrocortisone ekhaya futhi siqala ukuzizwa singcono ngemva kwemizuzu engu-30, singahlala ekhaya futhi siphumule. Sonke isiguli esithola umjovo we-hydrocortisone ophuthumayo ngenxa yesimo esisolekayo sokuqunjelwa kufanele sihanjiswe nge-ambulensi siyiswe emnyangweni wezimo eziphuthumayo.

Nakhu ukuthi kungani umjovo wasekhaya uyibhuloho kuphela lokuvuselela esibhedlela:

  1. Idosi ye-IM eyodwa ye-hydrocortisone iyaphela emahoreni angu-4 kuya kwangu-6: I-hydrocortisone ye-intramuscular ine-half-life ye-biological emfushane. Uma i-trigger engaphansi (efana ne-viral gastroenteritis, bacterial sepsis, influenza, noma inyumoniya) isasebenza lapho lowo mjovo owodwa uphela emahoreni angu-4 kamuva, isiguli sizophahlazeka sibuyele kwesesibili, inkinga ye-adrenal ejulile ngaphandle uma sisesibhedlela esiqhubekayo i-intravenous hydrocortisone ($200\umbhalo oqhubekayo noma amahora angu-2{4 mg} \(50\text{ mg}\) IV/IM njalo ngamahora angu-6).
  2. I-Hydrocortisone iyodwa ayikwazi ukufaka esikhundleni somthamo wegazi elilahlekile: Isiguli esisesimweni esibucayi se-adrenal silahlekelwe malitha oketshezi olungena emithanjeni nesodium. Imihlahlandlela ejwayelekile yemithi yezimo eziphuthumayo (i-Endocrine Society, UK Society for Endocrinology, kanye ne-NICE) igunyaza i-intravenous bolus esheshayo \(1,000\text{ milliliters}\) (\(1\text{ litre}\)) ye-isotonic \(0.9\%\) sodium chloride (usawoti ovamile) efakwe phakathi kwemizuzu engu-60 noma{30 yokuqala yabantu abadala\{30*) mL/kg}$ isotonic saline bolus yezingane), elandelwa amanye amalitha angu-3 kuya kwangu-4 engeziwe emahoreni angu-24 okuqala, ngokuvamile abhangqwa no-\(5\%\) dextrose (\(D5\text{NS}\)) ukuze kulungiswe i-hypoglycemia.
  3. Amashifu e-electrolyte asongela ukuphila adinga i-ECG yasesibhedlela kanye nokuqapha ilebhu: Ilabhorethri yasesibhedlela kuphela engakala i-serum potassium (ukuvimbela ukuboshwa kwenhliziyo ye-hyperkalemic), i-serum sodium (ukuvimbela ukulungisa i-hyponatremia engapheli ngokushesha kunokungu-\(8\text{kuya }ku-10\text{ mmol/L}\) ngamahora angu-24, okubangela i-osmotic infection kanye ne-osmotic demyeling bacteria ama-antibiotics.

Ukuvimbela: Ukwazi "Imithetho Yosuku Lokugula" ngaphambi kokuthi kuqale inkinga

Kufika kuhhafu wabo bonke abalaliswa esibhedlela ngenxa yezinkinga ze-adrenal gland kungavinjelwa lapho iziguli nemindeni isebenzisaImithetho Yosuku Lokugula Ngomlomo ophawu lokuqala lokugula ngokomzimba, imfiva, noma ukuhlukumezeka. Ngenxa yokuthi umzimba oncike ku-steroid awukwazi ukuphakamisa i-cortisol yawo, kufanele ulingise ngokuzenzakalelayo impendulo yokucindezeleka yemvelo:

Isifinyezo semithetho ejwayelekile yosuku lokugula lwamazwe ngamazwe (Izimiso Zabantu Abadala Nezingane)

Ukucindezeleka Komtholampilo / Isimo sokugula Ukulungiswa kwe-Oral Glucocorticoid (Hydrocortisone noma i-Prednisone/Prednisolone) Isikhathi Nesikhathi Sokulungiswa
Ukugula Okuncane Ngaphandle Kwemfiva (Amakhaza avamile anekhala eligijimayo kuphela, imihuzuko emincane) Ngokuvamile ALUKHO ushintsho oludingekayo. Uma ukhathele ngokungavamile noma ucanuzela inhliziyo, dlulela kuMthetho Wosuku Lokugula 1. Buyela kumthamo ojwayelekile uma izimpawu seziphelile.
Umthetho Wosuku Lokugula 1: Ukugula Okumaphakathi noma Imfiva \(\ge 37.5^\circ\text{C}\) (\(99.5^\circ\text{F}\)) (Ukugula okunjengomkhuhlane, ukucinana kwemigudu yokuphefumula, i-UTI, ukungenwa kwezindlebe, ukuqala imithi elwa namagciwane) PHINDA kabili isamba somthamo wansuku zonke we-oral steroid (isb., uma i-hydrocortisone evamile yansuku zonke ingu-\(20\text{mg}\), yenyuka ibe \(40\text{mg}\) ngosuku; uma uthatha u-\(5\text{mg}\) prednisone/prednisolone kanye ngosuku, yenyuka ibe \(10\text{mg}\) ngosuku). sakaza imithamo ngokulinganayo njalo emahoreni angu-4 kuya kwangu-6 ubusuku nemini, okuhlanganisa ubusuku bonke ukuze i-cortisol ingalokothi yehlele kuqanda. Qhubeka kuze kuphele umkhuhlane amahora angama-48. Ungalokothi kabili i-fludrocortisone.
Umthetho 2 Wosuku Lokugula: Imfiva Enzima \(\ge 39.0^\circ\text{C}\) (\(102.2^\circ\text{F}\)) PHINDA KAthathu isamba somthamo wansuku zonke we-oral hydrocortisone (kufika ku-\(60\text{ mg/day}\) kubantu abadala), ihlukaniswe njalo ngamahora angu-6 imini nobusuku, futhi ufune ukuhlolwa kwezokwelapha. Gcina kuze kube yilapho umkhuhlane wehla ngaphansi kokungu-\(37.5^\circ\text{C}\) (\(99.5^\circ\text{F}\)), bese wehlela phansi ukuze uthole umthamo ophindwe kabili izinsuku ezingu-2.
Isiqephu Esisodwa Sokuphalaza noma Sohudo Oluncane Ngokushesha thatha idosi yomlomo eyengeziwe ephindwe kabili (\(20\text{mg}\) hydrocortisone kumuntu omdala) ngemva nje kokuphela kokuhlanza, ngokuphuza okuncane kwesisombululo se-electrolyte. Uma ukuhlanza kwenzeka LESIBILI phakathi kwemizuzu engama-30 kuya kwengama-60, jova i-100 mg IM hydrocortisone ngokushesha bese ushayela ku-911 / 112 / 999.
Izinqubo Zamazinyo, Ukuhlinzwa, noma Ukubeletha Ukuhlanza amazinyo: U-\(10\umbhalo ongeziwe{kuya }ku-20\text{mg}\) oral hydrocortisone ihora elingu-1 ngaphambili.
Ukukhipha izinyo: Kufika ku-\(100\umbhalo{mg}\) oral/IM ngaphambili, kanye nomthamo ophindwe kabili amahora angu-24.
Ukuhlinzwa okukhulu noma ukuzala okusebenzayo: \(100\text{ mg}\) IV noma i-IM hydrocortisone ekungenisweni, kulandelwa u-\(200\text{mg}\)/24 amahora aqhubekayo we-IV.		 Thinta ngaphezulu kwezinsuku ezi-2 kuya kwezingu-3 ngemuva kwenqubo uma ukululama kungenabunzima.

Ukhulumela kanjani nabezimo eziphuthumayo kanye nodokotela begumbi lezimo eziphuthumayo

Lapho uphelezela isiguli esisesimweni esibucayi se-adrenal esibhedlela, sebenzisa lezi zinyathelo ezintathu: 1. Yethula Ikhadi Lezimo Eziphuthumayo Le-Steroid ngokushesha lapho lihlolwa: E-United Kingdom, nikeza Ikhadi Lezimo Eziphuthumayo le-NHS Steroid elibomvu. E-United States nase-Canada, nikeza i-National Adrenal Diseases Foundation (NADF) noma Incwadi Yephrothokholi Yegumbi Lezimo Eziphuthumayo Ye-Endocrine Society. Lawa makhadi ayalela abasebenzi abahlola izilinganiso ukuthi IV hydrocortisone (\(100\text{mg}\)) kanye IV \(0.9\%\) saline evamile (\(1,000\text{ mL}\) bolus) kufanele inikezwe phakathi nemizuzu engu-15 kuya kwengama-30 ifikile, NGAPHAMBI kokulinda imiphumela yokuhlolwa kwegazi elabhorethri. 2. Gcina isiguli silele sibheke ngohlaka: Ungalinge uvumele isiguli esinesiyezi noma isifo somfutho wegazi ophakeme sihlale siqondile esihlalweni segumbi lokulinda, njengoba ukuhlala uqondile kuhlanganisa igazi ezindaweni ezingezansi futhi kungase kubangele i-syncope noma ukuboshwa kwenhliziyo. 3. Phatha amakhithi amabili angaphelelwe yisikhathi ngaso sonke isikhathi: Hlola izinsuku zokuphelelwa yisikhathi njalo ezinyangeni ezingu-6, gcina ikhithi eyodwa ekhaya neyodwa esikhwameni sohambo, futhi ugcine izitsha phakathi kokungu-\(20^\circ\text{C}\) no-\(25^\circ\text{C}\) (\(68^\circ\text{F}\) kuya ku-$77^\circ\text).

Thatha isifundo

Ukuthatha inkambo yosizo lokuqala evela ku-Red Cross, i-St John Ambulance, noma inhlangano yendawo yokuqeqesha izimo eziphuthumayo, kuhlanganiswe nenqubo yomjovo we-intramuscular on orange noma pad yokuqeqesha nomhlengikazi wakho we-endocrinology, kwakha inkumbulo yemisipha edingekayo ukuze usebenze ngokuzola ngesikhathi senkinga yezokwelapha yangempela.

Imibuzo evame ukubuzwa

Can I accidentally harm or overdose someone by giving them a 100 mg hydrocortisone injection if it turns out they were not having an adrenal crisis?

No, a single emergency intramuscular injection of 100 milligrams of hydrocortisone (or the age-appropriate pediatric dose) will not cause any severe or lasting harm, even if the person turns out to have a simple illness rather than a true adrenal crisis. The notorious side effects of steroids (such as bone thinning, weight gain, or immune suppression) only happen after weeks or months of high-dose use, whereas withholding or delaying a single rescue injection during an actual adrenal crisis can lead to irreversible shock and death within hours.

Why can a person with Addison's disease not just take extra oral hydrocortisone pills when they have a stomach virus and are vomiting?

When a person has acute gastroenteritis with repeated vomiting or severe watery diarrhea, swallowed tablets are either expelled before dissolving or pass through the inflamed digestive tract without being absorbed into the bloodstream. At the exact same time, the infection and fluid loss double or triple the body's urgent demand for cortisol; therefore, any vomiting that prevents keeping oral tablets down for at least 30 minutes requires an immediate intramuscular injection that bypasses the gut completely.

What if I accidentally inject a small air bubble into the thigh muscle during the emergency injection?

Do not panic or waste precious minutes trying to flick out every microscopic bubble in the syringe. While large air pockets should be tapped to the top and pushed out so that you draw the full liquid medication volume, injecting a small air bubble into the dense thigh muscle (intramuscular route) is completely harmless and simply gets absorbed by the body's tissues; air bubbles are only a hazard when large volumes of air are injected directly into a major vein.

Can I use an EpiPen (epinephrine auto-injector) instead of hydrocortisone for an adrenal crisis?

No, an EpiPen contains epinephrine (adrenaline) for severe allergic anaphylaxis and does NOT replace cortisol or treat an adrenal crisis. In fact, when a person is in an adrenal crisis, their blood vessels lose the ability to respond properly to adrenaline until cortisol is restored; only an injectable corticosteroid (hydrocortisone, or if hydrocortisone is unavailable in a remote setting, injectable methylprednisolone, dexamethasone, or prednisolone) can reverse an adrenal crisis.

If the person feels much better 30 minutes after the home hydrocortisone injection, do we still have to go to the emergency room?

Yes, you must still go to the hospital by ambulance every single time an emergency hydrocortisone injection is given. A single intramuscular injection of hydrocortisone only protects the body for 4 to 6 hours and does nothing to replace the 2 to 4 liters of fluid and sodium lost from the bloodstream; hospital doctors must administer intravenous 0.9 percent normal saline, check blood potassium and glucose levels, treat the underlying infection, and maintain continuous IV or repeated IM steroid coverage until the patient can keep oral pills and fluids down for 24 hours.

Should a patient double their fludrocortisone (Florinef) tablets when they double their hydrocortisone for a fever?

No, patients with primary adrenal insufficiency generally do not need to double their daily fludrocortisone tablets when they double or triple their oral hydrocortisone for a fever or illness. Once total daily hydrocortisone reaches 40 to 50 milligrams or more (and certainly after a 100 milligram emergency injection), the hydrocortisone itself binds strongly to mineralocorticoid receptors and provides all the extra salt-retaining aldosterone activity the body needs.

Imithombo ihloliwe

  • I-Endocrine Society (i-United States) kanye ne-European Society of Endocrinology: Umhlahlandlela Wokuzilolonga Womtholampilo Wokuxilonga Nokwelashwa Kwe-Primary Adrenal Insufficiency (Bornstein et al., I-Journal of Clinical Endocrinology & Metabolism) kanye *Nemihlahlandlela Yokuzijwayeza Yomtholampilo Ohlangene ku-Glucocorticoid20 I-Insufficiency2000).
  • I-Society for Endocrinology (United Kingdom) kanye ne-Royal College of Physicians (United Kingdom): Isiqondiso Esiphuthumayo Sokuphathwa Kwe-Acute Adrenal Insufficiency (Inkinga Ye-Adrenal) Ezigulini Ezikhulile kanye Nesexwayiso Sikazwelonke Sokuphepha Kwesiguli: Ikhadi Lezimo Eziphuthumayo Le-Steroid Lokusekela Ukubonwa Kwangaphambi Kwangaphambi Nokwelashwa Kwabantu Abadala
  • I-British Society for Pediatric Endocrinology and Diabetes (BSPED, United Kingdom) kanye ne-National Institute for Health and Care Excellence (NICE, United Kingdom): Isiqondiso Sokulawulwa Kwe-Adrenal Insufficiency Ezinganeni Nentsha (NG243: Ukuntuleka Kwe-Adrenal: Identification and Management, 2024).
  • I-National Adrenal Diseases Foundation (NADF, United States) kanye neqembu le-Addison's Self-Help Group (ADSHG, United Kingdom): Imiyalo Yezimo Eziphuthumayo Yeziqondiso Ze-Solu-Cortef Act-O-Vial kanye ne-Hydrocortisone Sodium Phosphate Ampoules, Imithetho Yosuku Lokugula, kanye Nezimiso Zokunikezela Nge-EMS.
  • Inhlangano Yezempilo Yomhlaba (WHO): Ithuluzi Lemikhuba Engcono Kakhulu Yokujova Nezinqubo Ezihlobene (i-intramuscular vastus lateralis izimpawu zendawo ze-anatomical nezincomo ezingezona isifiso).

Iziqondiso ezihlobene