Things to note:
Medical Treatment:Acute crisis
- All patients should wear a notification bracelet.
- Hydrocortisone, IV, 200 mg 6 hourly.
Change to oral maintenance therapy once stable.
To maintain adequate intravascular volume guided by blood pressure:
- Sodium chloride 0.9%, IV.
The fluid deficit is often several litres.
Monitor glucose levels closely and treat hypoglycaemia if present. Chronic
As maintenance therapy:
- Hydrocortisone, oral.
- Start with 10 mg in the morning and 5 mg at night.
- Increase the dose according to clinical response up to 20 mg in the morning and 10 mg at night.
- Prednisone, oral.
- Start with 5 mg daily.
- Increase to maximum of 7.5 mg daily, if necessary.
For patients who remain symptomatically hypotensive:
- Fludrocortisone, oral, 50-100 mcg daily.
Monitor response to therapy with:
- Symptoms: Improvement in fatigue and GIT disturbances.
- Blood pressure: Normotensive and no postural drop.
- Electrolytes: Normal Na+ and K+.
During times of severe stress i.e. acute illness, surgery, trauma, etc:
- Hydrocortisone, IV, 100 mg 6 hourly.
With minor stress maintenance therapy should be doubled for the duration of illness and gradually tapered to usual dose. When to refer:
- All suspected cases for full evaluation.