Question: I recently had an episode of adrenal insufficiency and it is now suggested that I carry an emergency syringe. When exactly should I use the syringe?

Answer: In a patient who has adrenal insufficiency, and normally takes steroid replacement, the replacement dose should be increased in the setting of stress (such as fever or trauma), or fluid loss, as seen with gastrointestinal upset, such as with a GI bug. Inability to keep down steroids in these settings can cause progressive symptoms of adrenal insufficiency. In these settings, if steroids are either unavailable or cannot be kept down, all attempts should be made to go to a local emergency room, and steroids will be given by injection, along with intravenous fluids to prevent or treat dehydration. Patients with adrenal insufficiency should keep a steroid injection (either SoluCortef or Dexamethasone) with them as a preventative measure if he or she will be traveling far from a hospital, and should be administered only as a backup strategy if the symptoms become severe and the person doesn't have time to wait for an ambulance or travel to the nearest hospital. Clearly, if symptoms become severe to the point of unconsciousness, then the steroid should be given intramuscularly. Therefore, the steroid injection should be kept close to the patient during travel, such as on long drives or flights. Partners should receive instruction on how to administer the injection prior to travel, and be prepared to administer the steroid shot in the appropriate setting.