QuestionQA
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

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Steroid conversion
Topic
9
Internal Medicine
Normal dose of prednisolone per day = 5mg
Equivalent dose of hydrocortisone per day = 20mg
Double dose of hydrocortisone in line with sick day rules = 40mg

Note that most patients are given hydrocortisone as this is the most physiological choice of corticosteroid, although adherence might be an issue as this is a thrice-daily regimen. In addition, the reason why hydrocortisone is given instead is because prednisolone cannot be given intravenously.
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QuestionQAAnswer
40
mg
A 55-year-old patient suffers from Addison's disease and currently takes 5mg of prednisolone as a once-daily regimen. She has recently been taken ill with vomiting and unable to have any oral intake. The doctor decides to administer corticosteroid replacement using intravenous hydrocortisone instead with a view of doubling the normal dose in line with sick-day rules.


Given that 1mg of prednisolone is equivalent to 4mg of hydrocortisone, what is the total dose of hydrocortisone given per day?