Primary Adrenal Insufficiency sick day rules

• Take these doses on a daily basis when well

• 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

• 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

• 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

• 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

• 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