Patient Information
- Name: _________________________
- Date of Birth: _________________
- Primary Diagnosis: _____________
- Growth Hormone Deficiency: □ Yes □ No
- Adrenal Insufficiency: □ Yes □ No
Emergency Contacts
- Endocrinologist: _________________ Phone: _____________
- Primary Care Provider: ____________ Phone: _____________
- Emergency Contact: ______________ Phone: _____________
Warning Signs Requiring Immediate Action
Adrenal Crisis Symptoms
- Severe fatigue or weakness
- Severe abdominal pain, vomiting, or diarrhea
- Low blood pressure (dizziness upon standing)
- Confusion or loss of consciousness
- Cold, clammy skin
Emergency Instructions
-
For Patients with Adrenal Insufficiency:
- Inject emergency hydrocortisone immediately
- Adult dose: 100mg
- Pediatric dose: _____mg (as prescribed)
- Call 911 or go to nearest emergency room
-
For All Patients:
- Stop growth hormone injections during acute illness
- Resume only after consulting endocrinologist
Sick Day Management
- Double or triple oral glucocorticoid dose during illness
- Monitor blood glucose if diabetic
- Stay hydrated with clear fluids
- Contact endocrinologist if vomiting persists >12 hours
Hospital Instructions
- Show this card to emergency staff
- Inform about hormone replacement therapy
- Require immediate stress-dose steroids if applicable
Keep this plan accessible at all times
Documentation
- Plan Review Date: ________________
- Physician Signature: _____________
- Patient/Guardian Signature: _______