Why are steroid sick day rules important?
Minor ailments can have a potentially serious effect on anyone with a steroid-dependent adrenal condition.
This can either be due to your normal dose of steroids not being enough whilst you are unwell, or due to the symptoms of your illness interfering with how you absorb your steroid medication.
Common triggers of adrenal crisis
If you are not able to absorb your usual hydrocortisone medication, and are not able to meet any increased demands for cortisol, as a result of being under the weather, you are at risk of adrenal crisis.
An adrenal crisis is serious, uncomfortable and can be life-threatening.
It is worth noting that bereavement and stress (emotional or psychological stress) are also noted as triggers.
Learn more about adrenal crisis
When should you follow sick day rules?
The sick day rules are to always be used in the situations mentioned below, but may be needed in other scenarios too, if you feel you are heading into an adrenal crisis, irrespective of the cause.
Vomiting or diarrhoea
But you are still able to tolerate food and drink. Sip rehydration / electrolyte fluids
Need bed rest or antibiotics
An illness needing time in bed due to weakness or fatigue, or a course of antibiotics
A fracture or trauma
A fracture or other significant physical trauma
A fever
If you have a fever of over 37.5
Recommended dose in a 24-hour period
Start by immediately taking extra medication.
Updose for 48 hours. If you are feeling better, go back to your usual dose.
- If you don’t feel better after 48 hours, continue to updose and speak to your GP or your
endocrine nurse / doctor for more advice. - If you are prescribed antibiotics, continue to updose until you finish the course or feel
completely back to normal.
Everyone is different and you need to listen to your body. Your endocrine nurse / doctor can give you advice on how to taper your increased dose down safely.
Usual dose is 10-25mgWhen to use your emergency injection
High temperature
If your temperature is over 39 degrees, take 20mg of hydrocortisone every 6 hours (or 5mg of prednisolone every 6 hours) and seek immediate medical advice.
A high temperature like this indicates a severe infection or the start of an adrenal crisis.
Take paracetamol and increase your fluids
Can't keep medication down
- If you vomit and bring up your medication within 30 minutes of taking it, take a double dose again immediately.
- If bring up the second dose, inject yourself with 100mg of hydrocortisone and seek medical advice immediately.
Learn more about Adrenal Crisis - If you carry on vomiting, you will become dehydrated. You will need to go to hospital for a saline drip to prevent an adrenal crisis.
Frequently asked questions
The information contained on this page has been authored and reviewed by the ADSHG Clinical Advisory Panel.
Updated: April 2025.
