Adrenal insufficiency sick days

Steroids should never be missed. Any stress situation such as illness or surgery will need additional steroids.

Details

Name:

Date of birth:

NHS number:

Address:

Diagnosis:

Next of kin contact details:

GP contact details:

Paediatric lead consultant and hospital:

Paediatric endocrine team contact details:

Date of issue:

Steroid treatment

Oral sick day steroid treatment

This is in the event of an illness.

When to give additional steroids for sick days

Moderate to severe illness

Major trauma, severe illness or shock

Surgical and dental procedures

Tell the dentist, anaesthetist and other medical staff that your child has adrenal insufficiency and takes steroids.

Minor surgery

If your child is having minor surgery such as dental extraction under local anaesthetic, give your child a sick day dose before the procedure. Then give them their usual dose immediately afterwards.

However if they are in pain or feel unwell, give them sick day doses for up to 24 hours afterwards.

Major surgery

If your child is having major surgery such as an operation under general anaesthetic, give your child sick day steroids on the day of their procedure. Do this even if your child needs to fast (not eating or drinking beforehand).

Intravenous hydrocortisone needs to be given during the operation according to hospital protocol.

Vaccinations

If your child is having routine vaccinations and travel vaccinations, consider giving them 1 or 2 doses of sick day steroids. Continue to give them if they are still having symptoms.

Travelling

If your child is going on a long haul flight, give them their usual morning dose at 6 to 8 hourly intervals.

If my child is brought to hospital

If your child is brought to hospital, show this resource to the clinicians for them to follow.

1. Administer emergency intramuscular IV hydrocortisone if this has not already been done. Please check with parent or carer and ambulance crew
   • If baby is less that 1 year old, give them 0.25ml (25mgs) dose
   • If child is 1 to 5 years old, give them 0.5ml (50mgs) dose
   • If child is 6 years and older, give them 1ml (100mgs) dose
2. Check blood glucose. Give 2ml/kg 10% dextrose IV if their glucose is less than 3mmol/L
3. If circulation is compromised, give 10ml/kg 0.9% saline bolus
4. Obtain U&E and start IV fluids 0.9% saline or 5% dextrose at maintenance rate
5. Ongoing hydrocortisone doses:
   • Continue with IV hydrocortisone 2mg/kg (max 100mg) every 4 to 6 hours (or hydrocortisone infusion if very unwell)
   • Once stable, the IV bolus dose of hydrocortisone is 1mg/kg (max 50mg) every 6 hours
   • For neonates (less than 28 days) the IV bolus dose of hydrocortisone is 4mg/kg every 4 to 6 hours. Once stable, the IV bolus dose is 2mg/kg every 6 hours
   • Please refer to BSPED guidance for full details.
6. Once tolerating oral fluids, swap to oral sick day dosing until back to normal self (usually 2 to 3 days of sick day dosing)

Observe until they are tolerating oral steroids at sick day dosing. Contact acute paediatric or paediatric endocrine team if admission is required.

If they need a general anaesthetic or surgery, please contact the paediatric endocrine team for perioperative plan. The recommended doses for hydrocortisone are on the BSPED website.

For more information on adrenal insufficiency and how to give emergency injection of hydrocortisone, please scan our QR code, or type in https://tinyurl.com/26yfc82s to your browser.