COVID-19 - Adrenal Insufficiency and Steroid Dosing Guidelines
April 10, 2020
- When individuals with adrenal insufficiency (AI) are not sick and therefore not requiring stress dosing, they should not be taking higher or lower doses of hydrocortisone hoping it will protect them from getting sick. They should continue take their regular replacement dose as prescribed unless otherwise instructed by their physician.
- If they do get sick, increase the dose following stress dosing guidelines; you can find these guidelines on NADF’s website: Stress Dose Guidelines
- In cases of acute illness, increase the hydrocortisone dose per instructions and call the physician’s office for more details. In general, patients should double their usual glucocorticoid dose in times of acute illness
- Follow sick day rules for increasing oral glucocorticoids or injectables per your physician’s recommendations
- In case of inability to take oral glucocorticoids, contact your physician for alternative medicines and regimens
- If an acute condition develops, and the patient needs to be on a ventilator, the steroid dosing will depend on the specific circumstances of each individual. Generally, for ventilated patients, they will use stress dose IV hydrocortisone 100 mg every 8 hours, but there may be situations where a lower dose may be appropriate.