In this section : Covid-19
Molnupiravir
Sotrovimab
Conscious Proning
Covid-19 Basics
Remdesivir
Thromboprophylaxis
Identifying Patients in the Highest Risk Groups
Steroids for Patients with Covid-19 Infection
IL-6 Inhibitors – Tocilizumab or Sarilumab
Baricitinib
Paxlovid (Nirmatrelvir/Ritonavir)
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
- Adults should take 20 mg hydrocortisone orally every 6 h
- If on fludrocortisone, continue at usual dose
- Take paracetamol 1000 mg every 6 h for fever
- Rest, drink regularly and monitor how concentrated (dark) urine looks is to guide further fluid intake
- Request medical advice on the suspected COVID-19 infection
At Home – Beginning to Deteriorate
- Immediately inject (patient or carer) 100 mg hydrocortisone IM.
- Call for emergency medical attention for treatment and transfer to hospital, consider making their own way to hospital
- 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
- 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.
- 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.
- 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.
- Continuous IV fluid resuscitation with isotonic saline; regularly check urea and electrolytes
- Prescribe double the usual dose of oral Hydrocortisone on Hepma but suspend it for the duration of IM/IV Hydrocortisone therapy.
- Restart Hydrocortisone at double usual oral dose after completing Dexamethasone therapy.
Recovery – Improving Respiratory Function, Reducing or Normal Temperature
- Gradual tapering of stress dose hydrocortisone down to double regular replacement dose at time of discharge (endocrinologist to advise)
- Re-start usual fludrocortisone dose in adults when total daily hydrocortisone dose <50 mg