Sick Day Rules and Crisis Prevention

Because your body cannot produce its own cortisol, it cannot respond naturally to the “stress” of an illness or injury. In a person without Addison’s disease, the body automatically pumps out 5 to 10 times the normal amount of cortisol during a fever or trauma ^[1]. To stay safe, you must manually recreate this response using “Sick Day Rules” ^[2][3].

The Core Principle of Sick Day Rules

The goal of sick day rules is to increase your medication dose before your body enters a crisis. If you feel “different” or are coming down with an illness, you must adjust your dosage immediately ^[2][4].

• Minor Stress (Fever, Infection, or Minor Injury): If you have a fever (typically defined as >100.4°F or 38°C) or a significant infection (like the flu or a UTI), the standard practice is to double or triple your usual oral hydrocortisone dose ^[2][4]. Maintain this stress dose until the fever or acute illness resolves (usually 2-3 days).
• A Crucial Note on Fludrocortisone: Do not increase your fludrocortisone dose during sick days unless directed by your doctor. Doubling fludrocortisone during a routine illness can cause dangerous fluid retention, low potassium, and high blood pressure ^[2].
• Minor Procedures: For procedures like dental work or a colonoscopy, you will typically need an extra “stress dose” of hydrocortisone just before the appointment ^[5][6].
• Major Stress: For major surgeries or severe trauma, doctors will provide much higher doses of hydrocortisone, often through an IV ^[7][6].

When the Injection is Required

There are times when oral tablets are not enough or cannot be absorbed by your body. In these cases, you must use an emergency injectable hydrocortisone kit (often containing Solu-Cortef) ^[2][8]. The injection is usually given directly into the large muscle of the outer thigh ^[8]. We strongly recommend that you ask your doctor or nurse for a hands-on training session with a practice syringe so you and your family feel confident before an emergency strikes.

You must use your injection kit and call emergency services if:

1. You are vomiting: If you cannot keep your oral medication down, your cortisol levels will drop dangerously low within hours ^[2][9].
2. Severe Trauma: If you are in a serious accident or have a major bone fracture ^[2].
3. Signs of Crisis: If you feel an impending sense of doom, extreme weakness, or are becoming confused ^[10][11].

Note: An injection is a “bridge” to get you to a hospital. Even if you feel better after the shot, you must still seek medical evaluation immediately ^[8][12].

Your Emergency “Life-Saving” Kit

Every person with Addison’s disease should carry an emergency kit at all times ^[12][13]. A complete kit should include:

• Injectable Hydrocortisone: Usually 100mg of Solu-Cortef ^[2].
• Delivery Tools: Sterile water or saline for mixing, plus a syringe and needle ^[2][12].
• Instructions: A clear, waterproof card explaining how to mix and give the injection ^[2].
• Extra Oral Doses: A 3-day supply of your regular pills for stress dosing ^[13].

Identification and Communication

If you are unconscious or unable to speak, emergency responders need to know you have adrenal insufficiency immediately.

• Medical Alert Jewelry: Wear a bracelet or watch band that clearly states “Adrenal Insufficiency - Needs Cortisone” ^[6][14]. It is highly recommended to wear this on your wrist, as first responders are trained to check the wrists immediately when taking a pulse.
• Steroid Emergency Card: Keep a card in your wallet and a digital version on your phone’s lock screen ^[6][15].
• Educate Your Circle: Ensure your partner, roommates, or close coworkers know where your kit is and how to use it ^[16][12]. Your life may depend on their ability to act when you cannot.