2.01 - Adrenal Insufficiency / Crisis (Adult & Pediatric)

EMT-Basic (Standing Orders)

1.0 - Routine Patient Care
Identify and treat the underlying condition.
Consider paramedic intercept

EMT-Advanced (Standing Orders)

Obtain vascular access if appropriate

EMT-Paramedic (Standing Orders)

Stress dose:

Adult: History of adrenal insufficiency;
Administer:
Hydrocortisone 100mg IV/IO/IM or
Methylprednisolone 125mg IV/IO/IM.
Pediatric: History of adrenal insufficiency;
Administer:
Hydrocortisone 2mg/kg to a maximum of 100mg IV/IM/IO or
Methylprednisolone 2mg/kg to a maximum dose of 125mg IV/IM/IO

EMT-Paramedic (Medical Control)

Additional doses of above medications
In patients who continue demonstrating the following signs and symptoms, consult medical control for repeat stress dose orders:

Nausea, vomiting, weakness, dizzy, abdominal pain, muscle pain, dehydration, hypotension, tachycardia, fever, mental status changes.

Additional Considerations:

Aggressive volume replacement therapy.
Treat other conditions according to specific protocols.
Normalize body temperature.

Note:

Adrenal insufficiency results when the body does not produce the essential life-sustaining hormones cortisol and aldosterone, which are vital to maintaining blood pressure, cardiac contractility, water, and salt balance. Chronic adrenal insufficiency can be caused by a number of conditions:

Congenital or acquired disorders of the adrenal gland.
Congenital or acquired disorders of the pituitary gland.
Regular use of steroids (COPD, asthma, rheumatoid arthritis, and transplant patients).

Acute adrenal insufficiency can result in refractory shock or death in patients on a maintenance dose of hydrocortisone (SoluCortef) / prednisone who experience illness or trauma and are not given a stress dose and, as necessary, supplemental doses of hydrocortisone.

Note:

A “stress dose” of hydrocortisone should be given to patients with known chronic adrenal insufficiency who have the following illnesses/injuries:

Shock (any cause).
Fever >100.4°F and ill-appearing.
Multi-system trauma.
Drowning.
Environmental hyperthermia or hypothermia.
Multiple long-bone fractures.
Vomiting/diarrhea accompanied by dehydration.
Respiratory distress.
2nd or 3rd degree burns >5% BSA
Hypoglycemia

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