An unexpected adrenal crisis

This dose of methotrexate is proving difficult to get through.  Rory continued to be upset on Tuesday.  His emotional distress is magnified by sleep deprivation so Dr Kath suggested we give Rory a whole zopiclone tablet to help him sleep at night.  He largely slept through Tuesday night with the uridome working but on Wednesday morning he was very sleepy, slow and out of it.  His weight had ballooned by 3kg so he received furosemide to wring him out.  When I arrived at 11am I was very concerned about Rory’s condition so I got Dr Kath and the on call Dr in to check on him.  They suspected his sleepiness was caused by slow excretion of the zopiclone.  Rory slept until after lunch.  When he woke he was less out of it but he could only stay awake for a few minutes.  His eyes would roll back in his head, his eyelids would close and he would fall asleep, even sitting up with his mouth open.  His heart rate was elevated and his blood pressure low.  The Dr visited him several times in the afternoon but was stumped as to the cause.  I had a lightbulb moment at 5pm when it occurred to me his condition might be due to low cortisol.  He was in adrenal crisis.  I had to convince the Drs to start him on IV hydrocortisone.  Thankfully I have the most important of Rory’s medical notes at my fingertips.  Rory has now received three doses of IV hydrocortisone and this morning is a lot better.  His heart rate has come down, his blood pressure has increased and he is alert.  Unfortunately he has also gained nearly 3kg overnight so has just started furosemide again.  I am feeling a bit jaded due to the stress, the extra visits by the nurse overnight and the 4am start due to problems with the port and line.  It was all worth it to see Rory looking better this morning.