Managing when you’re sick

Your child may need to stay in hospital to receive intravenous (IV drip) hydrocortisone until they have stopped being sick. Gentle exercise such as recreational swimming or walking does not usually need extra medication. Challenging physical exercise such as competitive sport, may need extra medication.

  • Do not forget to tell the paramedics that your child is on steroid replacement.
  • Signs of crisis can include severe dizziness with serious vomiting and/or diarrhoea.
  • Challenging physical exercise such as competitive sport, may need extra medication.
  • The amount of increase needed, the way the cortisol is given and the length of time the increase is needed will vary depending on the situation you are in.
  • For individuals with Addison’s disease or hypopituitarism undergoing surgery it is considered best practice to collaborate with their consultant endocrinologist.
  • As well as a synacthen stimulation test, your thyroid gland may also be tested to see if it’s working properly.

However, if you are uncertain about your child’s treatment, speak to your doctor or specialist nurse. A total daily hydrocortisone dose of around 30/mg/m2/day given as four evenly spaced doses is recommended for illness. A guide to the doses is provided below; however the actual dose may vary depending on the strength and preparation of the available hydrocortisone medication. While this works well for treating coronavirus, the side effects can affect blood sugar management.

Causes of Addison’s disease

Although these symptoms aren’t always caused by Addison’s disease, you should see your GP, so they can be investigated. See note ‘switching back to oral glucocorticoids’  if already on a supraphysiological dose. For these journeys it is better to switch to 8 hourly treatment programme.

  • Patients can also download a PDF version as many will use it as the lock screen on their mobile phones to show health care professionals in a medical emergency.
  • Most people with the condition live a normal lifespan and are able to live an active life, with few limitations.
  • Because of this, they will need to have their sodium level checked in hospital.
  • This means they’ll be able to make sure you get any treatment you need appropriately and quickly.

This is really important if you go into hospital or if you need to take steroids as part of your treatment. Always tell the healthcare professionals treating you that you have diabetes. If you need to stay in hospital, the healthcare professionals responsible for your care will also need to know you need steroid replacement medicine throughout your stay. It should include prompts to check for risk of adrenal crisis and to identify whether the patient has a Steroid Emergency Card.

The Emergency Injection for the treatment of Adrenal Crisis

This factsheet show the signs and symptoms of an adrenal crisis. We have a fact sheet which outlines the signs to be aware of that may indicate impending adrenal crisis and advice on how to respond. Then call 999 for an ambulance, saying it’s an “adrenal crisis” or “Addisonian crisis”. You can also register yourself with your local ambulance service, so they have a record of your requirement for a steroid injection or tablets, if you need their assistance.

Giving the hydrocortisone injection

Normally, people produce more cortisol than usual in response to illness, injury and surgery. It is very important that children and young people receiving steroid replacement therapy increase their normal dose of steroids to copy this response. In cases of vomiting or shock, people with adrenal insufficiency can experience a sudden drop in blood pressure. If you do not take sufficient extra medication, you may experience an adrenal crisis which is a medical emergency.

Adjusting your medicine

The card includes areas for you to fill in your personal details, as well as basic information and a QR code linking to the SfE’s guide to treating adrenal insufficiency. Great Ormond Street Hospital have recently developed a free training app for giving an emergency injection of hydrocortisone. Your child’s condition should improve quickly, but you should still take them to hospital if you have given the hydrocortisone injection. If your child has diarrhoea, there is a risk that the oral hydrocortisone will pass through their too quickly and will not be absorbed.

Steroid sick day rules

For any sports with a risk of physical injury, you must ensure that a teammate has been trained to administer an emergency injection if needed. The adrenal glands also produce another hormone called mineralocorticoid. Back in 2020, a National Patient Safety Alert (NatPSA) was issued warning of the potential for adrenal crisis in steroid-dependent patients in the event of intercurrent illness. Specific guidance was given as to how to risk-stratify patients and what to do for each group.

NHS Steroid Emergency Card

This may involve a change to clinical practice for some adult rheumatology departments. You’ll usually need to have appointments with an endocrinologist every 6 to 12 months so they can review your progress and adjust your medicine dose, if necessary. Your GP can provide support and repeat prescriptions in between these visits. You’ll usually need to have appointments with an endocrinologist every 6 to 12 months so they can review your progress and adjust your medication dose, if necessary.