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Collapse in a patient with a history of corticosteroid use |
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Steroid Cover: If patients have received steroids in the past year or are on steroids require steroid cover for any stressful procedure, anaesthetic, infection, or episode of trauma with additional steroids – see protocol.
Collapse can be induced in such patients if steroid levels are insufficient. If collapse occurs such patients it is accompanied by pallor, a rapid and thin pulse, a sudden drop in blood pressure and loss of consciousness.
Management: ¨ Place supine ¨ Give 200—500mg hydrocortisone IV, or 500mg methylprednisolone IV immediately ¨ Maintain airway and supplement with oxygen if available ¨ Ensure help is requested ¨ Take blood for glucose and electrolytes ¨ Put up IV infusion of normal saline or glucose-saline. Give 1l over 2 hours, together with 200mg hydrocortisone sodium succinate, repeating this at 4—6 hourly intervals as required ¨ Monitor blood pressure ¨ Exclude other causes of collapse
Determine and treat underlying cause of collapse when blood pressure stabilized. Control pain and infection and give steroid supplement for at least 3 days after BP has returned to normal. |
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The use of corticosteroids therapeutically or otherwise may suppress the adrenal response to stress. This is more likely to happen with patients on long term steroids and high doses. |