Why are Sick Day Rules needed?
When your body is under either physical or severe emotional stress, it requires more cortisol than usual. Your daily steroid replacement medication will not be enough to cover this extra cortisol needed.
Physical stress
This might be something like an illness, accident or trauma.
Emotional stress
This might be something you are very worried about, like an exam, or an emotional shock, like a bereavement. Everyone is different, and for some people with a steroid-dependent adrenal condition, even relatively minor ailments can have a potentially serious effect.
Reduced absorption of your daily replacement medication or missing a dose
Symptoms of an illness (such as vomiting and diarrhoea) can interfere with the absorption of your normal daily medication as well as causing your body physical stress; a double whammy!
There may also be times when you know you are going to miss a dose of your medication, e.g. during surgery.
As you are steroid-dependent, you need 'steroid cover' at ALL times when you are not taking your medication.
Following Sick Day Rules helps prevent 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. This is a serious, uncomfortable and potentially life-threatening medical emergency.
Following the Sick Day Rules and increasing your daily cortisol replacement medication when you are physically unwell, under severe emotional stress, or when you feel 'low cortisol symptoms' keeps cortisol levels in your body where they need to be, helping prevent an adrenal crisis.
Learn more about adrenal crisis, including the common triggers
When should you follow sick day rules?
The Sick Day Rules should 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.
You are vomiting or have diarrhoea
But you are still able to tolerate food and drink. Sip rehydration /electrolyte fluids
You need bed rest or antibiotics
An illness needing time in bed due to weakness or fatigue, or a course of antibiotics
You experience a fracture or trauma
A fracture or other significant physical trauma
You have a fever
If you have a fever of over 37.5
Recommended Sick Day dosing
- Start by immediately taking extra medication when you start to feel unwell.
- Updose for 48 hours following the Sick Day dosing guidelines below.
- 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.
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.
Having a reserve supply of your essential steroid medication
So that you can follow the Sick Day Rules and increase your medication when you need to, we recommend always having a 3-month supply of your essential steroid medicine in reserve.
This is to ensure you have enough to keep you safe through an episode of illness which requires increased dosing, or to cover if there is a shortage of your medicine.
Following a joint campaign between the ADSHG and The Pituitary Foundation in 2025/6, recognition has been given to the requirement of people on essential steroid medication to receive 3-month prescriptions, rather than 1-month or 2-month.
Read more about our collaborative project
Use our Prescription Frequency letter template to send to your GP explaining your needs if you don't already receive a 3-month prescription.
When to use your emergency injection
For a high temperature (39 degrees or more)
- Take 20mg of hydrocortisone every 6 hours (or 5mg of prednisolone every 6 hours) and seek immediate medical advice.
- Take paracetamol and increase your fluids
A high temperature like this indicates a severe infection or could be the start of an adrenal crisis.
If you 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 you bring up the second dose, inject yourself with 100mg of hydrocortisone and seek medical advice immediately.
- 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.
Calling an ambulance
If you are not able to manage to give yourself an emergency hydrocortisone injection, or if no one is able to administer it for you, a paramedic will need to do it for you.
Even if you do have an injection (self-administered, or with support from someone else), you will still need to go to A&E for monitoring and fluids. Depending on what has caused your adrenal crisis, you may need further hydrocortisone. After administering an emergency injection, you will need to go to hospital
Click below for our Emergency page for help with administering your emergency injection and calling an ambulance.
Medication and sick day rules leaflet
Buy or download our leaflet to keep you safe and reduce the chances of an adrenal crisis when you are feeling unwell or are injured or ill.