Enda Patient Education Stress Dosing Self Admin

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name: enda-patient-education-stress-dosing-self-admin
description: Educates patients with primary adrenal insufficiency on adjusting glucocorticoid doses during stressful events such as fever, illness requiring bed rest, vomiting, or surgery, and on emergency self-administration of parenteral glucocorticoids to prevent adrenal crisis. Trigger phrases include 'fever >38°C', 'illness requiring antibiotics', 'persistent vomiting', 'pre-procedure fasting', 'surgical stress dosing education actions: Educate patient on sick‑day rules: double oral glucocorticoid dose for fever >38°C, illness requiring antibiotics or bed rest, or before minor procedures; triple dose for fever >39°C.
- Instruct patient to inject 100 mg hydrocortisone IM/IV/SC immediately for severe illness, trauma, persistent vomiting, or inability to retain oral meds, followed by 200 mg/24 h continuous infusion or 6‑hourly boluses.
- Provide steroid emergency card, medical alert bracelet, and a prescribed hydrocortisone emergency kit (vial, syringe, needles); review expiration dates.
- Emphasize need to seek medical help after self‑injection and to inform healthcare workers of adrenal crisis prevention strategies including parenteral self-or lay-administration of emergency glucocorticoids. (Ungraded best practice statement)
- Source: Diagnosis and Treatment of Primary Adrenal Insufficiency diagnosis.
- Document education, verify understanding, and schedule reinforcement at least annually or after any adrenal event.

## Clinical Guardrails / Mimics / Pitfalls
- Do not rely on oral dosing alone when vomiting or inability to swallow persists; delayed parenteral therapy increases mortality.
- Do not use dexamethasone as first‑line emergency glucocorticoid due to lack of mineralocorticoid activity and risk of inadequate crisis coverage.
- Avoid assuming patient knows injection technique without hands‑on demonstration and return‑demonstration.
- Do not omit the steroid card or medical alert; missing identification leads to treatment delays in emergencies.
- Do not use expired hydrocortisone vials; advise patients to check expiry every 6 months and replace as needed.

## Concrete Clinical Example
A 48‑year‑old man with PAI on hydrocortisone 15 mg AM/5 mg PM presents with fever 39.2 °C and vomiting after a gastrointestinal infection. He doubles his oral dose but cannot retain pills. He self‑injects 100 mg hydrocortisone IM, calls his endocrine nurse line, and receives instructions to continue 200 mg/24 h via 6‑hourly boluses while arranging urgent medical review.

**Source:** Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, https://doi.org/10.1210/jc.2015-1710