CRISES PREVENTION MEASURES IN PATIENTS WITH ADRENAL INSUFFICIENCY-ARE THEY BEING FOLLOWED?
AACE ePoster Library. Malhotra N. 05/14/15; 97735; 102
Dr. Nitika Malhotra
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Abstract
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Background: Subjects with adrenal insufficiency (AI) are at risk for developing adrenal crisis. It has been estimated that approximately 8% of patients with AI are hospitalized annually for adrenal crisis and only a few receive crises prevention education and have access to emergency glucocorticoid (GC) kits. Proper education prevents episodes of adrenal crisis. Aim of our study was to determine if education for prevention of adrenal crisis was being provided to patients with AI.
Methods: Data was collected from patients with AI from March 2009 through March 2014 by a retrospective chart review. Age, gender, causes of AI, GC dose, monitoring for hyponatremia and hyperkalemia, postural blood pressure, crises prevention education for GC dose adjustments during stress, MedicAlert ID and parenteral GC kit provision were recorded.
Results: There were 85 patients with AI, 33 (38.8%) with primary and 52 (61.2%) with secondary AI. Mean age was 55.8 years. There were 29 males and 56 females. 23 out of 85 patients (27%) had postural blood pressures checked of which 5 (21.7%) were positive. 77 out of 85 patients (90.6%) had monitoring done for electrolytes. The calculated replacement dose for steroids was 15-20 mg of hydrocortisone or its equivalent based on body surface area. Out of these 85 patients on steroids,there were 41 patients (48.2%) on doses above 20mg/day. Only 57 out of 85 patients (67.1%) had received steroid dose adjustment instructions and 29 out of 85 patients (34.1%) had Medic Alert ID. Only 17 out of 85 patients (20%) were given access to emergency parenteral GC kits.
Discussion: The preventive strategies for adrenal crisis in AI patients are not being consistently followed. Patient education is key for having a successful prevention strategy for adrenal crisis in patients with AI. We, as endocrinologists, have a responsibility to ensure that all patients with AI have Medic Alert ID and access to life saving emergency GC kits. Patients and families should receive adequate education about parenteral steroid administration and steroid dose adjustments in stressful situations.
Conclusions:Patients and their families are not being provided education related to prevention of adrenal crisis and osteoporosis.We are introducing an automated electronic alert in our electronic medical records to determine if this will improve adherence to these preventive measures.
Methods: Data was collected from patients with AI from March 2009 through March 2014 by a retrospective chart review. Age, gender, causes of AI, GC dose, monitoring for hyponatremia and hyperkalemia, postural blood pressure, crises prevention education for GC dose adjustments during stress, MedicAlert ID and parenteral GC kit provision were recorded.
Results: There were 85 patients with AI, 33 (38.8%) with primary and 52 (61.2%) with secondary AI. Mean age was 55.8 years. There were 29 males and 56 females. 23 out of 85 patients (27%) had postural blood pressures checked of which 5 (21.7%) were positive. 77 out of 85 patients (90.6%) had monitoring done for electrolytes. The calculated replacement dose for steroids was 15-20 mg of hydrocortisone or its equivalent based on body surface area. Out of these 85 patients on steroids,there were 41 patients (48.2%) on doses above 20mg/day. Only 57 out of 85 patients (67.1%) had received steroid dose adjustment instructions and 29 out of 85 patients (34.1%) had Medic Alert ID. Only 17 out of 85 patients (20%) were given access to emergency parenteral GC kits.
Discussion: The preventive strategies for adrenal crisis in AI patients are not being consistently followed. Patient education is key for having a successful prevention strategy for adrenal crisis in patients with AI. We, as endocrinologists, have a responsibility to ensure that all patients with AI have Medic Alert ID and access to life saving emergency GC kits. Patients and families should receive adequate education about parenteral steroid administration and steroid dose adjustments in stressful situations.
Conclusions:Patients and their families are not being provided education related to prevention of adrenal crisis and osteoporosis.We are introducing an automated electronic alert in our electronic medical records to determine if this will improve adherence to these preventive measures.
Background: Subjects with adrenal insufficiency (AI) are at risk for developing adrenal crisis. It has been estimated that approximately 8% of patients with AI are hospitalized annually for adrenal crisis and only a few receive crises prevention education and have access to emergency glucocorticoid (GC) kits. Proper education prevents episodes of adrenal crisis. Aim of our study was to determine if education for prevention of adrenal crisis was being provided to patients with AI.
Methods: Data was collected from patients with AI from March 2009 through March 2014 by a retrospective chart review. Age, gender, causes of AI, GC dose, monitoring for hyponatremia and hyperkalemia, postural blood pressure, crises prevention education for GC dose adjustments during stress, MedicAlert ID and parenteral GC kit provision were recorded.
Results: There were 85 patients with AI, 33 (38.8%) with primary and 52 (61.2%) with secondary AI. Mean age was 55.8 years. There were 29 males and 56 females. 23 out of 85 patients (27%) had postural blood pressures checked of which 5 (21.7%) were positive. 77 out of 85 patients (90.6%) had monitoring done for electrolytes. The calculated replacement dose for steroids was 15-20 mg of hydrocortisone or its equivalent based on body surface area. Out of these 85 patients on steroids,there were 41 patients (48.2%) on doses above 20mg/day. Only 57 out of 85 patients (67.1%) had received steroid dose adjustment instructions and 29 out of 85 patients (34.1%) had Medic Alert ID. Only 17 out of 85 patients (20%) were given access to emergency parenteral GC kits.
Discussion: The preventive strategies for adrenal crisis in AI patients are not being consistently followed. Patient education is key for having a successful prevention strategy for adrenal crisis in patients with AI. We, as endocrinologists, have a responsibility to ensure that all patients with AI have Medic Alert ID and access to life saving emergency GC kits. Patients and families should receive adequate education about parenteral steroid administration and steroid dose adjustments in stressful situations.
Conclusions:Patients and their families are not being provided education related to prevention of adrenal crisis and osteoporosis.We are introducing an automated electronic alert in our electronic medical records to determine if this will improve adherence to these preventive measures.
Methods: Data was collected from patients with AI from March 2009 through March 2014 by a retrospective chart review. Age, gender, causes of AI, GC dose, monitoring for hyponatremia and hyperkalemia, postural blood pressure, crises prevention education for GC dose adjustments during stress, MedicAlert ID and parenteral GC kit provision were recorded.
Results: There were 85 patients with AI, 33 (38.8%) with primary and 52 (61.2%) with secondary AI. Mean age was 55.8 years. There were 29 males and 56 females. 23 out of 85 patients (27%) had postural blood pressures checked of which 5 (21.7%) were positive. 77 out of 85 patients (90.6%) had monitoring done for electrolytes. The calculated replacement dose for steroids was 15-20 mg of hydrocortisone or its equivalent based on body surface area. Out of these 85 patients on steroids,there were 41 patients (48.2%) on doses above 20mg/day. Only 57 out of 85 patients (67.1%) had received steroid dose adjustment instructions and 29 out of 85 patients (34.1%) had Medic Alert ID. Only 17 out of 85 patients (20%) were given access to emergency parenteral GC kits.
Discussion: The preventive strategies for adrenal crisis in AI patients are not being consistently followed. Patient education is key for having a successful prevention strategy for adrenal crisis in patients with AI. We, as endocrinologists, have a responsibility to ensure that all patients with AI have Medic Alert ID and access to life saving emergency GC kits. Patients and families should receive adequate education about parenteral steroid administration and steroid dose adjustments in stressful situations.
Conclusions:Patients and their families are not being provided education related to prevention of adrenal crisis and osteoporosis.We are introducing an automated electronic alert in our electronic medical records to determine if this will improve adherence to these preventive measures.
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