Sick Day Rules for Hydrocortisone in Adrenal Insufficiency
Yes, you should double your hydrocortisone dose during minor illness (fever, infection, vomiting, diarrhea) to prevent adrenal crisis. 1, 2
Standard Sick Day Protocol
During minor to moderate illness, double your usual hydrocortisone dose for the duration of the illness, typically 48 hours to one week depending on recovery. 1, 2 This means if you normally take 10 mg in the morning, you would take 20 mg during illness.
When to Double Your Dose
You should double hydrocortisone when experiencing:
- Fever (temperature >38°C/100.4°F) 1
- Vomiting or diarrhea 1
- Significant infection (respiratory, urinary, etc.) 1, 2
- Non-specific malaise with somnolence 1
- Any physiological stress requiring medical attention 1, 2
Duration of Stress Dosing
- Continue doubled doses for 48 hours after symptoms resolve for minor illness 1
- May need to continue up to one week for more significant illness 1
- Return to normal maintenance dose once fully recovered 1, 2
Critical Escalation: When Doubling Is Not Enough
If you cannot keep oral medication down due to vomiting, or if you develop severe symptoms (confusion, severe weakness, hypotension), you need immediate intramuscular or intravenous hydrocortisone 100 mg. 1, 3 This is an adrenal crisis and requires emergency medical attention.
Emergency Injection Indications
- Persistent vomiting preventing oral intake 1
- Severe diarrhea with inability to absorb medication 1
- Altered mental status or confusion 1
- Collapse or severe hypotension 1
- Any situation where you cannot take or absorb oral medication 1
Essential Safety Measures
All patients with adrenal insufficiency must have an emergency hydrocortisone injection kit at home and a trained family member who can administer it. 1, 4 The risk of adrenal crisis is 6-8 cases per 100 patients per year, with significantly increased mortality if untreated. 4
Required Patient Resources
- Medical alert bracelet or necklace identifying adrenal insufficiency 1, 4
- Steroid emergency card carried at all times 1
- Home emergency injection kit with 100 mg hydrocortisone for IM/IV use 1
- Written sick day rules accessible to patient and family 1
Common Pitfalls to Avoid
Do not wait to see if symptoms improve before doubling your dose—start immediately when illness begins. 1, 2 Delayed treatment increases the risk of progression to adrenal crisis. The guideline explicitly states: "Listening to a well-informed adrenal patient who says that he or she needs additional steroids, and taking urgent action, will avoid unnecessary deaths from this eminently treatable medical problem." 1
Do not confuse your maintenance dose (10 mg) with stress dosing. 2 Your baseline 10 mg is not a "stress dose"—it is your normal replacement. During illness, this becomes 20 mg. 2
Never abruptly stop doubled doses. 1 Taper back to your maintenance dose over 1-2 days once symptoms have fully resolved to avoid rebound insufficiency. 1