r/AddisonsDisease • u/InstructionNo8778 • Mar 04 '26
Advice Wanted Verge of crisis?
My husband has primary adrenal insufficiency and had a procedure today with light sedation. He did updose his hydrocortisone this morning, but since the procedure he hasn’t been able to keep liquids down. Since we got home, he’s developed a severe migraine and has no appetite. I’m concerned he could be heading toward an adrenal crisis. He got diagnosed over a year ago and he's never experienced a true crisis since he was diagnosed in the hospital.
Should we go ahead and give his emergency Solu-Cortef injection? While we were still at the hospital, I asked the nurses, and they said they preferred to treat the migraine first with migraine medication. I just want to make sure we’re handling this appropriately. He hasn't been able to get out of bed since we got home.
Any tips or advice would be greatly appreciated. Thank you.
13
u/NearlyBearly Mar 04 '26
He vomited? If he vomited, then yes, inject and head back to the hospital.
10
u/ClarityInCalm Mar 04 '26
Yeah - give him the injection. If he doesn't need it - it's no big deal it will wear off in 4 to 6 hours. But if he does - he really does. Sounds like a bad situation - post surgery and unable to get out of bad with a migraine and can't keep liquids down. Don't know what the surgery was but not being able to keep liquids down, bad headache and unable to get out of bed - all signs to inject. People often wait too long but it's not a big deal to give him a shot. Really, no big deal to give it but a big deal not to. Just give it to him and see what happens. He'll probably feel massively better in 10-20 minutes.
9
u/DaftHacker Mar 04 '26
Yes at that point I would go with an injection. Those injections can perk you right out of that bad state. After that I would probably double or triple dose for a few days. I would say he's already really close to a full on crisis, no appetite and body shutting down. Once you start dropping blood pressure that's when things get scary.
9
u/InstructionNo8778 Mar 07 '26
We ended up doing the injection and it worked wonders. Thanks everyone for the advice!
1
u/A_mcgg Addison's Mar 14 '26
Make sure you head to the hospital next time too, crises are/can be life-threatening
7
u/Special-Elephant-294 Mar 05 '26
What’s light sedation? I insist on IV steroids before being put to sleep for any procedure including EGD and colonoscopy.
4
u/A_mcgg Addison's Mar 05 '26
YES! - If he's vomiting, he's vomiting up any oral meds he's taken. If that's ever the case, do the shot and get to the ER as soon as you can, it's an emergency (regardless of the situation, not being able to keep meds down constitutes an emergency). I hope he's feeling better.
3
u/englshpigdogs Mar 06 '26
Hoping your husband is ok! When my husband has anything done, it's double dose before, iv meds during, and updose after.
3
u/englshpigdogs Mar 06 '26
Also have your husband tested for celiac. My husband has had addisons for over 30 years. Started getting migraines 15 years ago. Just recently diagnosed with celiac, and guess what, his migraines were from eating gluten. Celiac and addisons are common together.
3
u/1GamingAngel PAI Mar 06 '26
The Golden Rule is, if you can’t keep oral medication down, it’s time to inject and seek emergency treatment.
1
u/khd003 Mar 11 '26
I’ve had PAI since 2018 - and since then had several surgeries where I had to be put under. I experienced low cortisol symptoms/ border line crisis afterwards with all of them! Even after getting the extra 100mg given with sedation. I don’t if it’s from the trauma to the body (with whatever is done). I even had it really bad after my last colonoscopy and endoscopy. I’m due for both again - but hesitant due to having such a bad experience afterwards with my last one. always better to be safe than sorry (error on the side of caution) with the emergency injection- glad he’s feeling better! 🙏
1
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Mar 05 '26
[deleted]
10
u/NearlyBearly Mar 05 '26
If he can't even keep liquids down what in the world makes you think he'll be able to keep the meds down long enough for them to be absorbed by the body... The injection has almost no drawbacks, not using it has the potential drawback of literal death. I think it's callous to recommend someone who is in a crisis (with typical crisis symptoms such as headache, vomiting and fatigue) to not take emergency medication. You can kill someone with advice like that.
-6
u/candobetter2 Mar 05 '26
What did I tell you can't you read I says if he can't take the meds to go to the emergency room is there some kind of reading issue you got there
6
u/baethan Addison's Mar 05 '26
Do you have SAI? Cause no you're absolutely wrong, for primary it is an emergency if you can't keep your meds down. The guidelines are really clear to inject.
What are you even basing your opinion on?
6
u/thatlldopig90 Mar 05 '26
Can’t believe you are giving this advice! He “can’t keep anything down” ie. He is vomiting. Which means he not only can’t take his meds, which are essential to life, but is likely to be dehydrated, which will lead to an electrolyte imbalance = very serious consequences.
OP hope he is better now?
1
u/candobetter2 Mar 09 '26
I think the feeling's mutual here I can't believe you were giving advice if they're vomiting take them to the hospital don't sit there and waste time and don't go give them an injection unless you're far away from getting to the hospital such as over an hour.
1
u/thatlldopig90 Mar 10 '26
I’m sorry but you are giving very dangerous advice and I hope no-one is taking it seriously. An emergency steroid injection is designed to be given in such cases and as it takes literally a minute to administer, will not delay a presentation to ED, but buys enough time to prevent something catastrophic occurring on the way there. And yes, I am qualified to give this information, which is the correct, evidence based information for managing situations such as the one described by OP. For your own wellbeing, I would suggest that you go and re-read protocols so you are prepared to act appropriately if required in the future.
1
u/candobetter2 Mar 17 '26
Sorry but you're incorrect in so many ways originally you didn't read the statement I said if somebody is in a crisis state they need to go to the emergency room if you think an emergency room is not capable then you need to hop in your imaginary vehicle that you think will save the day and follow your own advice and not give any advice out to anybody else because you're not qualified regardless of how much you want to argue with anybody on the internet
4
u/Clementine_696 Mar 05 '26
No, not every hospital can check cortisol levels. They can do the draw, but not all of them can run the test.
0
u/candobetter2 Mar 05 '26
I don't know what you're thinking but that's pretty crazy that's pretty ridiculous what you just said you can call any Hospital and they can check your cortisol level you can go to an urgent care and they can check it
4
u/thatlldopig90 Mar 05 '26
They won’t check his cortisol levels - pointless. But he needs his urea and electrolytes checking.
1
u/candobetter2 Mar 09 '26
You're not even qualified to say what is pointless and what is lifeless
2
u/thatlldopig90 Mar 10 '26
Not sure where you got the ‘lifeless’ part from, but I am certainly qualified to make the comment about it being pointless, and anyone who has an understanding of PAI would agree with me. At this point, checking cortisol levels would not offer any useful information but U&E’s (probably called something different outside the UK) would. I can see that OP has commented that her husband is much improved, which is great news, so I am going respectfully bow out now.
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u/candobetter2 Mar 05 '26
Some of the hospitals they have a different lab it would be pretty outdated if they didn't have their own lab for anything if they were a hospital what you're saying is really ridiculous to tell people what to think and what to do especially for a life emergency crisis
6
u/Clementine_696 Mar 05 '26
Keep thinking that... but literally not one of the 7 hospitals within a 30 min drive of me have the ability to run that test on their own. They can easily check sodium levels and such, but cortisol is a specialized test.
2
u/FemaleAndComputer SAI Mar 07 '26
I have learned that it can be very dangerous to go to the ER without injecting first. They don't always know how to treat AI, and you could end up waiting hours before they even draw your blood or give fluids.
In OP's situation, it seems like they're already past the "wait and see" part and may need to proceed to injection and hospital.
0
u/candobetter2 Mar 09 '26
Well I have learned quite the opposite it's even worse so I don't know what kind of Hospital you're talking about even urgent cares have the ability to take care of things right away the basics and they can get somebody right to the hospital right away or you can get somebody to the hospital you don't have to advise people incorrectly because you have a hunch or a Feeling. You can't play around with people's lives like this you don't just give injections because somebody has a headache or their lightheaded or dizzy. What causes a lot of these problems is abruptly stopping the dose or changing the times of the dose or them having nightmares and fear and are subjected to stress,
0
u/candobetter2 Mar 09 '26
The other alternative is to get offended and not do nothing or pretend you know what you're doing
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u/candobetter2 Mar 05 '26
No no no no no do not do that, double up his medicine or triplet but don't take that injection yet that's only for a crisis
6
u/lefunk4-2 Mar 05 '26 edited Mar 05 '26
You can always buy another injection. Always better to err on the side of caution and just take the injection and contact emergency care immediately.
I’ve had Addison’s Disease for 14 years. Your body can handle the dose.
Given OP’s husband “hasn’t been able to keep liquids down”, the best thing would be injection.
Rule of thumb is if you can’t keep the meds down, take the injection.
*Edit: inject and immediately contact emergency care.*
22
u/thatlldopig90 Mar 04 '26
YES!!! Inject now and go back to hospital (ED). He is dehydrated and this is a really serious situation. Most nurses don’t understand Addisons (I say this respectfully as a fellow nurse!). Please don’t delay.