Addison's disease, also called adrenal insufficiency, is a chronic condition caused by dysfunction of the adrenal glands. Cortisol, an essential steroid hormone is not secreted in adequate amounts leading to altered blood chemistry and inflammation. Just as diabetics may experience a medical crisis with low blood sugar, so too can patients with Addison's disease experience an "Addisonian crisis" if corticosteroid levels drop too low. Patients with Addison's should carry emergency steroids (much like an epi-pen) in case this should occur.
A DOCS Education member writes in:
I am planning to sedate a patient with Addison's disease. Her Primary Care Provider said she needs prophylactic antibiotics. A scan of internet sources yields scant but mixed recommendations on whether or not she should be pre-medicated with antibiotics for routine restorative dentistry. The new protocols for heart and joints don't mention Addison's. Is there a right or wrong answer? Does she need really need antibiotic prophylaxis?
Dr. Jerome Wellbrock, DOCS Education faculty member, responds:
I cannot find any recommendations for antibiotic prophylaxis in cases adrenal insufficiency either. Usually the concern is the need for any additional glucocorticoid coverage. I would recommend contacting the PCP to make sure there is not a misunderstanding or miscommunication on anyone's part. Any risk you may encounter will be based on the level of stress your patient has and the length of time and treatment provided. Be certain to have complete knowledge of the level of the patients disease and complete information on any medications they are taking and run and interaction analysis with your planned sedation drugs.
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