Primary Adrenal Insufficiency sick day rules

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Detailed instructions for sick day and emergency management of adrenal insufficiency. Refer to the table below.

Summary of Adrenal Insufficiency Sick Day Rules

SituationInstructions
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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About the Author MyEndoConsult

The MyEndoconsult Team. A group of physicians dedicated to endocrinology and internal medicine education.

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