PSA: Adrenal Insufficiency and Sunburns (AKA an ER visit for IV fluids)

If you have adrenal insufficiency, be EXTREMELY CAREFUL when you get sunburned. A sunburn is a major trauma to the largest organ of the human body, the skin. Depending on the severity of the sunburn, it is either classified as a first degree or a second degree burn. It is known to cause dehydration and to require extra cortisol. In a human with fully functional adrenal glands, cortisol levels are known to rise in order to facilitate the healing of the sunburn.

Why do I feel the need to make this public service announcement?

My mother and I made an ER trip around 9pm on Thursday, August 24th. I had gotten severely sunburned on a gulf coast beach the day before. I made the error of not reapplying sunscreen after swimming in the water (despite my mother's recommendation). I also completely missed applying sunscreen to my left hip. Immediately after leaving the beach, my skin did not appear that red.

However, as the night progressed, my back and hip turned significantly more red. We made a trip to a local pharmacy to purchase some aloe vera gel (I only buy gel that has aloe vera as the first ingredient) and some vitamin E lotion (I absolutely love the Australian Gold scent).

Thursday morning, I honestly thought I was doing well. The sunburn on my hip hurt, but it was not unbearable. I was able to attend an art exhibit of legos, and spend some time at a mall. My mom noticed me beginning to fade around 3PM. I took additional salt tabs and cortisol. By 4:45PM, we realized that I would be unable to handle dinner in a public place. I took additional oral Cortef to sustain me until I could get where we were staying to put in a new pump site. With the new pump site ( ... when in doubt, change it out... ), I increased my pump rates to "super sick" or triple dose.

Even with an increase in cortisol, I was not improving. After several upset stomach episodes, and one unproductive vomiting session, my mom and I decided to head to the ER around 8:30PM. I knew my cortisol coverage was more than adequate. But that is only half of the equation with adrenal insufficiency. I was severely dehydrated. I needed IV fluids.

At the ER, I was immediately triaged as a Level 2. The triage nurse stated that this was the highest she could give me. Level 1 they reserved essentially for those flown in by helicopter on the brink of death. They were able to get me back to a private room almost immediately and start IV fluids on me within the hour. However it took them over an hour to deliver Solu-Cortef due to a Level 1 patient arriving around the same time as me.

I was not incredibly concerned with the delay of Solu-Cortef because I knew they were working as fast as they could AND I was covered with cortisol through my cortisol pump. However, this brings up a very important point: ALWAYS INJECT SOLU-CORTEF BEFORE HEADING TO THE ER. I was a Level 2 triage. I had the highest level allowed without being dead. They treated me as urgently as they physically could. I had a private room in under twenty minutes while other patients were on beds in the hallway for over five hours. But even with high level of urgency, I still had over an hour wait before receiving an injection. An injection at home buys you precious time.

The ER staff at this hospital was absolutely amazing. We went to Tampa General Hospital, which is the main teaching hospital associated with University of South Florida. I was visited by a med student, a resident, and an ER doctor. The med student loved the flow charts provided by Adrenal Insufficiency United and requested to take pictures of them. The resident admitted that in cases like mine, it is crucial for him to listen to the expert in the room about the rare disease. And the expert is me. The ER doctor validated our decision to seek emergency medical treatment because a sunburn is a form of extreme physical trauma that taxes the adrenal glands.

I was released six hours later, after multiple bags of saline fluids, additional Solu-Cortef, and a migraine cocktail that involved Benadryl and Reglan.

This did restart the counter for my number of ER free years. Prior to this episode, my last ER visit resulted in a three day hospitalization due to food poisoning from poorly cooked chicken in Kuala Lumpur, Malaysia. That episode occurred August of 2014.

But it is ok that I had to restart that counter.

Honestly, that number was artificially inflated due to my abuser. On three separate occasions, I begged my abuser to take me to the ER for IV fluids. He refused, telling me to shut up, stop being overly dramatic, he had the situation under control, and that I was "fine." He would then leave the room, often while I was still writhing in pain and agony. Once it was because his celebratory steak dinner was getting cold. Another time, he wanted to watch a different movie with my friends from college. The third time, he did not want to drive the fifteen minutes to the closest ER during the night. 

The ER staff expressed gratitude that I escaped such a covertly physically abusive marriage.

I am free.

I am safe.

And with the support of my family, friends, and amazing emergency medical personal, I shall remain Clearly Alive.

Perhaps by typing them out in a list, I'll follow my own advice.

• SUNSCREEN: Use it. Reapply immediately after exiting the water. It is better to PREVENT a sunburn than to TREAT a sunburn.
• ALOE: Constantly apply aloe to the burn. As soon as it dries, reapply. This facilitates healing. I prefer aloe gel that is alcohol free and with aloe juice as the first ingredient.
• ALOE WITH LIDOCAINE: The ER doctor suggested I use this before I go to bed. The short lived numbing agent will help reduce pain enabling me to fall asleep. 
• CORTISOL: Immediately increase cortisol dose. Severe sunburns seem to require a triple dose for me.
• IV FLUIDS: If the sunburn is severe enough and you notice your adrenal insufficiency start to flare, seek emergency medical treatment immediately. But be sure to inject before you head off to the ER or the ED.

I do not regret my trip to the beach.