Detailed instructions for sick day and emergency management of adrenal insufficiency. Refer to the table below.
Summary of Adrenal Insufficiency Sick Day Rules
| Situation | Instructions |
Maintenance (Usual) Doses- Take these doses on a daily basis when well
| |
Sick Day Management (“Stress Dosing”) - With any physical stress such as infection or injuries, the body need higher amounts of hydrocortisone
- In the event of fever (above 38 Celsius or 100.4 Fahrenheit), infection that requires antibiotics, vomiting, diarrhea, or fracture, use the higher doses for 24 to 48 hours
- Resume usual (maintenance) doses of hydrocortisone when fever/stress has resolved
| - Stress dose is typically double or triple usual daily dose. Call Endocrinology Team
|
Emergency Management(Solu-Cortef Injection) - When unable to tolerate oral medication, hydrocortisone by injection will be necessary
- In the event of severe illness, trauma, inability to tolerate oral hydrocortisone, unconsciousness, or repeated vomiting, administer Solu-Cortef by intramuscular injection
| Solu-Cortef (100 mg in 2 mL)- Age under 3 years → administer 25 mg (0.5 mL) by intramuscular injection
- Age 3-10 years → administer 50 mg (1 mL) by intramuscular injection
- Age above 10 years → administer 100 mg (2 mL) by intramuscular injection
Go to the emergency Department or call 911 Call Endocrinology Team |
Preparation for Surgery - The stress of surgery and recovery from it necessitates higher doses of hydrocortisone during and 1-3 days after surgery
- This requires team approach among the healthcare professionals managing the surgery and post-operative care
| Make the surgeon (or dentist) and anesthesiologist aware- Diagnosis of adrenal insufficiency and medication doses
Surgical team and endocrinology should communicate with each other - Plan well before the date of surgery
- Decide on hydrocortisone doses before and after surge
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