Ensure all steroid-dependent patients given new emergency card, prescribers told

A new NHS Steroid Emergency Card is being launched to improve early recognition and treatment of adrenal crisis.

Stopping steroids in patients with primary or secondary adrenal insufficiency can lead to adrenal crisis, which is a medical emergency. | GETTY IMAGES
Stopping steroids in patients with primary or secondary adrenal insufficiency can lead to adrenal crisis, which is a medical emergency. | GETTY IMAGES

The new card helps healthcare staff to identify steroid-dependent patients and gives information on the emergency treatment needed if the patient becomes acutely ill, or experiences trauma, surgery or other major stressors.

A recently issued CAS alert asks healthcare professionals to ensure all eligible patients are issued with the card, and to put processes in place to check if a patient has a card before any emergency treatment, elective surgery, or other invasive procedures.

The NHS Steroid Emergency Card should be issued to all patients with primary adrenal insufficiency, such as those with Addison’s disease, congenital adrenal hyperplasia, or hypothalamo-pituitary damage from tumours or surgery.

Some patients who take oral, inhaled or topical steroids for other medical conditions may develop secondary adrenal insufficiency and be steroid dependent. Those taking prednisolone 5mg/day or equivalent for 4 weeks or longer across all routes of administration, or inhaled beclamethasone >1mg/day or fluticasone >500 microgram/day, should be issued with the card.

Interrupting steroid treatment in patients with primary or secondary adrenal insufficiency can lead to adrenal crisis, which is a medical emergency and can be fatal if left untreated. If these patients become acutely ill or are subject to major body stressors, such as from trauma or surgery, they require higher doses of steroids to prevent an adrenal crisis.

A search of the National Reporting and Learning System (NRLS) for a recent two-year period identified four deaths, four patients admitted to critical care, and around 320 other incidents involving issues with steroid replacement therapy for patients with adrenal insufficiency or emergency treatment for adrenal crisis.

The card includes a management summary for the emergency treatment of adrenal crisis alongside a link to the Society for Endocrinology emergency management guidelines. It can be issued by any healthcare professional managing patients with adrenal insufficiency or prescribing steroids.

If there is any doubt as to who should carry an Steroid Emergency Card, or uncertainty about the diagnosis of adrenal insufficiency, liaison with the local endocrinology team is advised.

'This guidance and the NHS Steroid Emergency Card should prompt all healthcare professionals to consider adrenal crisis in patients carrying the card, initiate appropriate management for surgery or invasive procedures and treat patients rapidly and appropriately when presenting as an emergency,' say the authors of the Society for Endocrinology guidance for the prevention and emergency management of adrenal insufficiency.

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