Months on prednisolone, then a stomach bug — why is she collapsing?
Long-term steroids switch off the body’s own cortisol. Miss them, especially when ill, and there may be nothing left to cope.
Select any card for the reasoning, what to watch for and an exam tip.
The puzzle
A 72-year-old woman has taken prednisolone daily for eight months for giant cell arteritis. A vomiting bug stops her keeping tablets down, and she runs out over a bank holiday. Two days later she is drowsy, dizzy on standing, and her blood pressure is very low.
The answer, step by step
Who is most at risk
- Prednisolone (or equivalent) at the BNF’s Steroid Emergency Card threshold for 4 weeks or longer, by any route.
- High doses for more than a week, or repeated short courses.
- A short course within a year of stopping long-term steroids.
- Anyone vomiting, or facing surgery or a serious infection.
What to do
Key takeaway
After more than a few weeks of steroids, the adrenals can’t make enough cortisol on demand. Never stop suddenly, ask the GP about the dose when unwell, carry a Steroid Emergency Card, and give injected hydrocortisone in a crisis.