Patients on long-term corticosteroids cannot mount a normal cortisol response to physiologic stress (illness, surgery, trauma) because of HPA-axis suppression. The standard sick day rule is to double or triple the daily oral dose during minor illness, but if the patient cannot keep oral medication down because of vomiting or diarrhea, parenteral hydrocortisone (50 to 100 mg IV or IM) is required to prevent adrenal crisis. Skipping the dose, waiting 24 hours, or telling the patient to triple at home while vomiting all risk progression to crisis: hypotension, hypovolemia, hypoglycemia, hyperkalemia, hyponatremia, and shock. The nurse instructs the patient to come in for parenteral steroid, IV fluid resuscitation, antiemetics, and evaluation of the underlying illness. Patients should also know to seek care for surgery, severe trauma, or any persistent inability to take oral medication.
For study reference only. Always follow current clinical guidelines and your institution’s protocols.