Why Are Sick Day Rules for Steroids Necessary?
During times of physical stress like illness or injury, healthy adrenal glands naturally produce more cortisol. Individuals with adrenal insufficiency, either due to conditions like Addison's disease or long-term steroid use, cannot produce enough cortisol to handle this stress. This deficiency can lead to a severe, life-threatening condition called an adrenal crisis, characterized by symptoms such as dizziness, low blood pressure, vomiting, confusion, and abdominal pain. Sick day rules are vital guidelines for adjusting steroid dosage during illness to prevent this medical emergency.
Who Needs to Follow Steroid Sick Day Rules?
Anyone who is steroid-dependent must follow these rules, including individuals with primary (e.g., Addison's disease) or secondary/tertiary adrenal insufficiency (caused by pituitary issues or long-term high-dose steroid use). This also applies to those taking 5mg or more of prednisolone (or equivalent) for four weeks or longer, or those who have stopped long-term steroid therapy within the past year. Carrying an NHS Steroid Emergency Card or wearing medical identification is recommended for all affected individuals.
The Two Golden Rules of Steroid Sick Days
- NEVER Stop Taking Your Steroid Medication: Always continue taking your steroids, even if you feel unwell or are vomiting, as stopping can cause an adrenal crisis.
- INCREASE Your Steroid Dose When Unwell: Increase your steroid dose to provide the extra cortisol needed to cope with the stress of illness. The required increase depends on the severity of your illness.
General Sick Day Dosing Guidelines
Disclaimer: This is general guidance. Always follow the specific plan provided by your endocrinologist or healthcare provider.
Minor Illness (No Fever)
For mild illnesses like a common cold without a fever, your usual steroid dose is often sufficient. You should monitor your symptoms and increase the dose if your condition worsens or you develop a fever.
Moderate Illness (Fever, Infection)
Moderate illness includes fever above 38°C (100.4°F), infection requiring antibiotics, or feeling unwell enough to be confined to bed. The action required is to double your usual daily oral glucocorticoid dose. Continue the double dose until you are recovering and have been fever-free for 24-48 hours. If taking antibiotics, continue the double dose until the course is finished. Contact your doctor if you remain unwell after 72 hours.
Severe Illness, Vomiting, or Trauma
This constitutes a medical emergency requiring immediate action. This includes persistent vomiting or diarrhea, major injury, fainting, or preparation for major surgery. In this situation, administer an emergency hydrocortisone injection. If you vomit your oral steroid dose, retake it. If you vomit again, you will likely need to use your emergency 100mg hydrocortisone injection into a large muscle. After the injection, immediately call 999 or go to the nearest emergency department and state you are having an "adrenal crisis".
| Illness Severity | Common Triggers | Action Required |
|---|---|---|
| Minor Illness | Common cold, no fever | Continue usual steroid dose. Monitor for worsening symptoms. |
| Moderate Illness | Fever >38°C (100.4°F), flu-like symptoms, infection requiring antibiotics, bed rest | Double the usual daily oral steroid dose until recovered. |
| Severe Illness / Emergency | Persistent vomiting or diarrhea, major injury, pre-surgery, severe drowsiness or confusion | Use your emergency 100mg hydrocortisone injection and call 999 or go to the hospital immediately. |
The Steroid Emergency Injection Kit
An emergency injection kit is a critical component for individuals with adrenal insufficiency. It is prescribed by a doctor and provides injectable hydrocortisone for use when oral medication cannot be taken or is insufficient. A typical kit contains a vial of 100mg hydrocortisone (either liquid or powder for mixing), syringes and needles, alcohol wipes, and instructions. It is important that the individual and close contacts are trained to use the kit and that the medication's expiry date is checked regularly.
Conclusion
Managing adrenal insufficiency during illness hinges on understanding and implementing steroid sick day rules. Key principles involve consistently taking your medication and increasing the dose when the body is stressed by illness. Preparedness with a treatment plan, extra oral steroids, and an up-to-date emergency injection kit is crucial for preventing adrenal crisis. Carrying a steroid emergency card is vital, and if in doubt, increasing the dose and seeking medical advice is generally the safer course of action.
For further reading and patient support, visit the {Link: Addison's Disease Self-Help Group https://www.addisonsdisease.org.uk/}
