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Home | Articles | Covid-19 | Covid-19 Sick Day Rules for Patients with Primary Adrenal Insufficiency

Covid-19 Sick Day Rules for Patients with Primary Adrenal Insufficiency

Last updated 6th January 2021

At Home – Onset of Signs & Symptoms Suggestive of COVID-19

  1. Adults should take 20 mg hydrocortisone orally every 6 h
  2. If on fludrocortisone, continue at usual dose
  3. Take paracetamol 1000 mg every 6 h for fever
  4. Rest, drink regularly and monitor how concentrated (dark) urine looks is to guide further fluid intake
  5. Request medical advice on the suspected COVID-19 infection

At Home – Beginning to Deteriorate

  1. Immediately inject (patient or carer) 100 mg hydrocortisone IM.
  2. Call for emergency medical attention for treatment and transfer to hospital, consider making their own way to hospital
  3. If patients cannot be taken or kept in hospital, then they should take 50 mg hydrocortisone every 6 h orally at home.

In Hospital – Steroids for Severe or Critical COVID

  1. The criteria for escalating steroids in severe or critical COVID are as follows: –
    • oxygen saturation < 90% on room air
    • respiratory rate > 30 breaths per minute in adults
    • signs of severe respiratory distress (i.e. accessory muscle use, inability to complete full sentences)
    • acute respiratory distress syndrome (ARDS), sepsis, septic shock or other conditions that would normally require the provision of life-sustaining therapies, such as mechanical ventilation (invasive or non-invasive) or vasopressor therapy
    • on CPAP or mechanical ventilation.
  2. Rx Hydrocortisone 100 mg per IV injection in adults followed by 50 mg every 6 h per IV or IM bolus injection for 7-10 days.
  3. Suspend Fludrocortisone if continuing Hydrocortisone (as above) but if using Dexamethasone 6 mgs for 7-10 days instead of Hydrocortisone, continue Fludrocortisone as Dexamethasone has minimal mineralocorticod action.
  4. Continuous IV fluid resuscitation with isotonic saline; regularly check urea and electrolytes
  5. Prescribe double the usual dose of oral Hydrocortisone on Hepma but suspend it for the duration of IM/IV Hydrocortisone therapy.
  6. Restart Hydrocortisone at double usual oral dose after completing Dexamethasone therapy.

Recovery – Improving Respiratory Function, Reducing or Normal Temperature

  1. Gradual tapering of stress dose hydrocortisone down to double regular replacement dose at time of discharge (endocrinologist to advise)
  2. Re-start usual fludrocortisone dose in adults when total daily hydrocortisone dose <50 mg

Links

  1. COVID-19 resources for managing endocrine conditions – Society for Endocrinology
  2. Letter to Patient [docx]