"emergency pred"

[Clarbeston]

Recently one of you lovely knowledgeable people posted that you always carry emergency pred when out and about. My question is in what circumstances would you envisage needing it and at what dose? Would it depend on where one is on the reduction schedule?( I'm currently at 4.5/4. ) If it is an emergency , for example, adrenal crisis, surely the time taken to absorb the pred wouldn't help. Has anyone been in such a situation and what happened? As always, so grateful for all your input.

[123-go]

Circumstances when you might need to draw from your emergency pack of Pred could include:

… if you are staying away from home and experience transport delays

… if you have a flare of symptoms and need extra pred to deal with that.

These possibilities would apply at any dose and around a year after stopping prednisolone.

It’s also advisable to carry a blue steroid dose card and a red emergency card: you may have these. The blue one is a for a record of your pred doses that you yourself enter and the red emergency card is to guide medical professionals in the (hopefully) unlikely event that you are taken into hospital. See following link:

westessexccg.nhs.uk/your-he...

MrsNails posted the following in FAQs:

healthunlocked.com/pmrgcauk...

Apologies if you already know about these cards/ have them in your possession.

[Clarbeston in reply to 123-go]

Thanks for the information.. reminders never hurt!

[PMRpro Ambassador]

You never know what can happen - the apocryphal knocked down by a bus! Being taken ill and stuck somewhere might result in you getting to time for a dose of pred and no pred. When away from home you may have had just enough to take you over the time you were expecting to be away.

I set off from a campsite on the last day of the holiday only to discover the motorway AND the main road that was the normal relatively short route home taking 2 hours were closed after 2 major accidents - they remained closed for several hours so the tailbacks were enormous.I had a hospital appointment so we went over the mountain and just made it but had it not been for that we'd have just stayed where we were, waited for the mess to clear and gone home the next day. I see similar situations on a regular basis in tourist season - journeys that normally take 6 hours take 13 just because of the heavy traffic.

You are right that in the case of an adrenal crisis you might not be able to swallow the pills - but in that case you would be so unwell an ambulance call would be justified. But most people start to feel confused, disorientated and unwell in time to get tablets down.

[Clarbeston in reply to PMRpro]

Good advice as always, thank you.

[Purpleazalia]

I was on 4mg of pred and was a little worried about the fact I would be having medication and an iodine fluid injected during a CT scan. I had taken my usual dose that morning but put a strip of 5mg tablets in my bag 'just in case'. All went well on that occasion, but...

I had 2 dental appointments where more treatment was done than expected. I felt a bit shakey after the first one and needed to sit in the waiting area until I felt fit enough to leave. I didn't feel the need to take extra pred because I felt okay dealing with it.

Because of this I took 5mg on the day of the 2nd appointment. Again the dentist had to do more work than expected (this time to put right problems caused by her work at the previous appointment!). I got very stressed by the length and type of work. When she had finished I felt terrible, I was too shaken to get out of the dental chair and burst into tears.

I mentioned now knowing what an adrenal crisis felt like and, as I remembered my strip of 5mg tablets, told them I needed to take one in the hope it would help and stop me needing an ambulance to be treated. In part, my comments to them were to make sure they would call for help if I collapsed. I might have been panicking and over-dramatic - but that was how I felt at the time!

The logical part of me tells me that the extra pred hadn't had time to get into my system by the time I felt well enough to leave the surgery, but perhaps it stopped me flaring after the trauma!

[PMRpro Ambassador in reply to Purpleazalia]

There is some there in half an hour and prednisolone works immediately, With prednisone there is an extra hour while it is processed by the liver to make prednisolone, the active form.

[Clarbeston in reply to Purpleazalia]

Thanks for your interesting story..I have some dental work coming up next week and I'll be sure to make them aware.

[Purpleazalia in reply to Clarbeston]

I would add that I've had other dental appointments/treatment at 4 and 5mg, including a minor op at the hospital to remove a lesion from my gum - all without problems 🙃

[Clarbeston in reply to Purpleazalia]

Good to know.

[SnazzyD]

Talking from the adrenal crisis side of things, there needs to be a distinction between over doing it because one has been a silly billy and over stepping the ability of your adrenal glands to produce cortisol to deal with your situation. Adrenal crisis feels horrible and you really feel deeply in trouble. You can feel nauseated, shaky like being low in blood sugar but eating doesn’t help after 15 mins even if one’s sugar is low as well. The blood pressure drops so standing up can make one feel quite faint and the legs don’t want to work. This has happened a few times for me, out of the blue in the early days of low adrenal function but also much later in unusually demanding situations. I’ve usually managed on 1-2mg Pred but then laid or at least sat for a couple of hours. This was an attempt at not taking more, but one has to feel one’s way. If it happens with being ill as well more may be necessary and if one’s own dosing doesn’t help, get urgent medical opinion. I had a complete collapse in July after a week of unrelenting high fever and in the end diarrhoea as well (may have been adrenal crisis starting). I could stand up and felt a deep doom. Paramedics gave me a shot of hydrocortisone before carting me off to A&E and it was a wonder drug before I even got into the ambulance.

[Clarbeston in reply to SnazzyD]

We seem to be on a knife edge which is why I asked how others coped with emergency situations. Thanks for your reply.

[MrsNails]

It’s hard to be specific but sometimes you just know!……

I was in the airport & started to feel most unwell - dizzy, not quite with it, leaden legs & as we approached the desk to go through to the plane a young man offered me his seat…..

I took Two 5mg Prednisolone & they started to dissolve in my mouth (yuk) while my husband got me a drink of water……

We were coming back from Australia via LA & l’d adjusted my dose accordingly but l think it just caught up with me……

[Clarbeston in reply to MrsNails]

Thanks for your reply. I will be sure to carry some pred with me henceforth.