{"id":3424368,"date":"2022-07-31T17:03:36","date_gmt":"2022-07-31T21:03:36","guid":{"rendered":"https:\/\/myendoconsult.com\/learn\/?p=3424368"},"modified":"2023-03-16T04:56:42","modified_gmt":"2023-03-16T09:56:42","slug":"primary-adrenal-insufficiency-sick-day-rules","status":"publish","type":"post","link":"https:\/\/myendoconsult.com\/learn\/primary-adrenal-insufficiency-sick-day-rules\/","title":{"rendered":"Primary Adrenal Insufficiency sick day rules"},"content":{"rendered":"

Detailed instructions for sick day and emergency management of adrenal insufficiency. Refer to the table below.<\/p>\n

Summary of Adrenal Insufficiency Sick Day Rules<\/h2>\n\n\n\n\n\n\n\n
Situation<\/strong><\/td>\nInstructions<\/strong><\/td>\n<\/tr>\n
Maintenance (Usual) Doses<\/strong><\/p>\n
    \n
  • Take these doses on a daily basis when well<\/li>\n<\/ul>\n<\/td>\n
<\/td>\n<\/tr>\n
Sick Day Management (\u201cStress Dosing\u201d) <\/strong><\/p>\n
    \n
  • With any physical stress such as infection or injuries, the body need higher amounts of hydrocortisone<\/li>\n
  • 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<\/li>\n
  • Resume usual (maintenance) doses of hydrocortisone when fever\/stress has resolved<\/li>\n<\/ul>\n<\/td>\n
\n
    \n
  • Stress dose is typically double or triple usual daily dose. Call Endocrinology Team<\/strong><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Emergency Management(Solu-Cortef Injection) <\/strong><\/p>\n
    \n
  • When unable to tolerate oral medication, hydrocortisone by injection will be necessary<\/li>\n
  • In the event of severe illness, trauma, inability to tolerate oral hydrocortisone, unconsciousness, or repeated vomiting, administer Solu-Cortef by intramuscular injection<\/li>\n<\/ul>\n

    \u00a0<\/strong><\/td>\n

Solu-Cortef (100 mg in 2 mL)<\/strong><\/p>\n
    \n
  • Age under 3 years \u2192 administer 25 mg (0.5 mL) by intramuscular injection<\/li>\n
  • Age 3-10 years \u2192 administer 50 mg (1 mL) by intramuscular injection<\/li>\n
  • Age above 10 years \u2192 administer 100 mg (2 mL) by intramuscular injection<\/li>\n<\/ul>\n

    Go to the emergency Department or call 911 <\/strong><\/p>\n

    \u00a0<\/strong>Call Endocrinology Team<\/strong><\/td>\n<\/tr>\n

Preparation for Surgery <\/strong><\/p>\n
    \n
  • The stress of surgery and recovery from it necessitates higher doses of hydrocortisone during and 1-3 days after surgery<\/li>\n
  • This requires team approach among the healthcare professionals managing the surgery and post-operative care<\/li>\n<\/ul>\n<\/td>\n
Make the surgeon (or dentist) and anesthesiologist aware<\/strong><\/p>\n
    \n
  • Diagnosis of adrenal insufficiency and medication doses<\/li>\n<\/ul>\n

    Surgical team and endocrinology should communicate with each other <\/strong><\/p>\n

      \n
    • Plan well before the date of surgery<\/li>\n
    • Decide on hydrocortisone doses before and after surge<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n","protected":false},"excerpt":{"rendered":"

      Detailed instructions for sick day and emergency management of adrenal insufficiency. Refer to the table below. Summary of Adrenal Insufficiency Sick Day Rules Situation…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[92],"tags":[],"class_list":["post-3424368","post","type-post","status-publish","format-standard","hentry","category-endocrine-reviews-adrenal"],"_links":{"self":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/posts\/3424368","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/comments?post=3424368"}],"version-history":[{"count":18,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/posts\/3424368\/revisions"}],"predecessor-version":[{"id":4415722,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/posts\/3424368\/revisions\/4415722"}],"wp:attachment":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/media?parent=3424368"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/categories?post=3424368"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/tags?post=3424368"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}