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Post by Lethal Lee on Mar 16, 2009 2:37:02 GMT -5
Correct ranges are as follows
Aldo Renin Salt Fasting 24 hours Test Ranges Tested ~8am Fasting overnight Cycling women week one (day 3 ideally) recommended. Men & Postmeno Women test any day
Aldo Males...... 6-22. Females.. 6-28 (first week of cycle) ...............6-31 (other times)
Renin 3-24 Salt Fasting Upright (sitting or standing) Range
I now have the last 2 labs - Aldosterone.. 2.4 (< 21) Renin............ 0.6
The Aldo range appears to be for Males & is incorrect. As above correct range for week 1 is (6-28) or (6-31) other times so your result of 2.4 is clinically deficient regardless of when in cycle you tested.
Your Renin of 0.6 is also clinically deficient assuming you Salt fasted 24 hours?
Hertoghe says any Aldo below 9 definitely needs Florinef. Minimum needed is higher than midrange results. Probably best to retest if these results were prior to HGH and prior to changing to Pred.
While low Aldo & Renin usually is assoc with Secondary AI as is low Sodium & low Potassium but not always. There are exceptions such as myself. I am definitely Secondary AI as per ACTH Stim & ACTH results. However I had low Aldo, elevated Renin, suboptimal Sodium & deficient Potassium. ACTH Stim test with ACTH takes priority over Aldo Renin for diagnosis. Without a ACTH Stim then ACTH Serum, 8am Cortisol, Saliva Cortisol, Renin & Potassium are the "next best" for dxing.
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Post by rebecca on Mar 17, 2009 18:31:19 GMT -5
I had the insulin stress test to dx the secondary AI. I find all of this intriguing and frustrating that there isn't more research on the subject. I am curious about the fluid retention that I had BEFORE I started on the steroids. I have had varying degrees of pitting edema in my legs for a decade along with incredible thirst and voiding. The pitting edema got worse when I started in synthroid BEFORE the steroids were started - (because they didn't initially dx me at pituitary insuff). After the steroids, the pitting edema is gone, the thirst less but I still go through phases as well as the salt craving less but still through phases. I tried restricting my salt before the test but did have a quesadia at midnight - not sure how much salt in that - I suppose some in the cheese. I will ask for levels since the switch to prednisone. The thirst has increased since the switch. How long does it take to straighten this all out? I finally took a medical leave from work. I can't be up and about for more than 4 hours which is a GREAT improvement but still get dizzy. The fatigue is dramatically better as well but the swimming feeling in my head is frustrating! Do you know if people combine prednisone and cortisone to get the best from both?
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Post by rebecca on Mar 20, 2009 18:57:56 GMT -5
I just survived the scariest health situation I have ever had. We were traveling with a large group of people and half or our group was overcome by a stomach flu or food poisoning. I tried taking my stress dose of HC but couldn't keep it down. It was amazing how fast I got weak. In less than 3 hours I could barely feel my pulse and had trouble thinking, but knew enough to know I needed an ER and IV steroids. They make epi pens for allergies - do they make steroid emergency injections for people like us? I knew what I needed and it was unfortunate to have to go to an ER to get it. The poor EMT was trying not to panic because he couldn't find my pulse and couldn't hear my BP - I kept saying as long as I'm talking we are OK but I was having a harder and harder time talking. The ER nurse didn't "get" the situation either - fortunately the ER MD "got it" right away and had them start an IV and give me the steroids (125 mg methylprednisone I think, I was so out of it I'm a bit vague on some of those details before the steroids)) and then 2 liters of fluid. My pulse never got less than 98 and my bp was still 88/50 to 102/50 when I left.
Now, this all leads to my dosing question. The next day (yesterday) I took my regular dose of prednisone and then added in 10 mg HC in the afternoon when I started feeling weak. Today I have been feeling progressively weaker and dizzier and took an extra 5 mg of HC (in addition to my prednisone). I have no flu symptoms but still haven't eaten more than a few crackers in the last 2 days. Keeping my fluids up, though. How long do you keep stress dosing?
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Post by justaustin on Mar 21, 2009 7:35:00 GMT -5
Rebecca,
Sorry to read about your adrenal crisis. Do you have a medic alert bracelet? This would direct them to what you need should you become unresponsive/unstable.
Yes, they have emergency cortisol injection kits. Have your doc order one with X# refills. Keep one with you at all times. Keep tabs on expiration date. Have doc reorder yearly.
Sounds like you need to continue stress dosing. Listen to your body. It might take a bit of time for your body to recover from the crisis, nevermind the flu. You might need a bit more than 5 or 10mg of HC. I wouldn't wait until the afternoon when you feel weak, to add in the HC either. Need to start earlier in the day. See how you feel. Reminder: when you stress dose for more than two days, you will need to wean back to usual dosing(after you have recovered or on the upswing of the illness)
Have you been drinking sea salted water?
Hope you feel better(soon), Laurie
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Post by rebecca on Mar 21, 2009 22:40:22 GMT -5
How many days do you give yourself to recover? This is something I can't find any info on anywhere. Do you just see if you wake up dizzy or get dizzy and then know that you need more? I started the sea salt today. Had two 1/4 tsp "doses". YUCK! Tried one in orange juice and one in hot water - is there an easy way to get this down or do you get used to it? How much should I aim for per day?
Also I have not been able to find any info on line regarding low aldosterone/low renin that doesn't also involve diabetes or kidney dysfunction. I have found several good medical textbooks on line regarding endocrine and aldosterone, if you want me to i will link them here or in a private message - your choice. Please let me know if you find any sources.
Also, I did get a medical ID right away - but I felt like no one really understood the urgency or how fast I was failing. The poor EMT got it when he couldn't feel my pulse.
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Post by Lethal Lee on Mar 22, 2009 2:04:15 GMT -5
Hi Rebecca, Just wanted to stress that you DO need to get Doc to rx SoluCortef for use in an emergency. What would have happened if you were unable to get to the Hospital? What you need is script for 100mg SoluCortef. It comes in a vial that you need a needle & syringe to draw out . It must be administered intra muscularly. I just had me Doc do the same & now have 2 vials at home "just in case". I would have some with me (plus extra rx repeats) for any trips, holidays, etc I went on too. Wise to have a nurse show you AND your partner/room mate/parent how to draw up a syringe & administer an injection too. Note if illness continues then 100mg SoluCortef may need to be given every 6-8 hours. Here is a link to the SoluCortef Activial product media.pfizer.com/files/products/uspi_solucortef.pdfMaintaining electrolytes when unable to eat & if vomiting, diarreah etc is important too. I use an alkaliser product called Alkala N by Sanum contains Potassium & Sodium Bicarb. It has no unpleasant taste in fact I use it daily as Sea Salt is a problem for me. Here is link with info about it if interested www.hormonesupportgroup.proboards.com/index.cgi?action=display&board=adrenals&thread=571&page=1#3106A medical bracelet & wallet card is also a very good idea. I have had these for some time but need to update them to reflect current dx & rx, Docs details etc. Important to have engraved on the bracelet "Adrenal Insufficiency: If injured/unresponsive inject 100mg SoluCortef either I.V. or I.M." As to how long it takes to "recover" that is too variable to say with any certainty. Having adequate Cortisol, maintaining electrolytes & Glucose levels will certainly speed recovery.
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Post by rebecca on Mar 22, 2009 11:54:27 GMT -5
Ok I read the info on the Alkala N - but please clarify for me - does it support both the sodium and the potassium? My K+ has been running 3.8 so I am cautious to push it any lower with lots of salt. We already drink alkalized water so according to the web site I'm doing something right regarding the ph! Also the web site wouldn't let me link into any suppliers.
I have a med ID but need to get a card in my wallet - "my bad". I'm a nurse and my husband was a military medic so we are both good on injections - just need to get the meds. I feel so fortunate that it did happen where there was an ER - it was a frightening learning experience. The kids have been drilled - what do you tell people if Mom is hurt or found sick - "Get her steroids - now". They even told the EMT's when they came to get me! How did you get that many words engraved on an ID - I haven't been able to find one that carries that much - I have on it "adrenal insufficiency - cortisone dependent".
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