Q: Is there a remedy for severe vomiting and blackouts when I have a crisis? I take extra tablets but bring them up when I am sick.

A: The only way to avoid vomiting and blackouts associated with crisis is to avoid having a crisis! These are intrinsic features of severe adrenal failure. This should not occur under normal circumstances. Patients should be aware of the need to increase the dose of hydrocortisone when they suffer from simple day to day infections or other physical illnesses so that crisis does not occur. If abdominal upsets such as gastro-enteritis, diarrhoea or vomiting from food poisoning occur then they or their relatives must be taught how to give an intramuscular injection of hydrocortisone to deal with an emergency since the tablets will not be kept down. We teach a close member of the family as well as the patient themselves how to give an intramuscular injection of hydrocortisone and always dispense an emergency pack containing the hydrocortisone injections and the necessary syringes. It must be stressed that when a patient with Addison's Disease has vomiting or severe diarrhoea they must be given injections of hydrocortisone either in this way by a family member or by a nurse or doctor.