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Adrenal Sick-Day Rules — RACP Adult Medicine MCQ

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EasyEndocrinologyAdrenal Sick-Day RulesRACP Adult Medicine

A 45-year-old woman with Addison disease asks about sick-day management. She currently takes hydrocortisone 15 mg mane/5 mg afternoon and fludrocortisone 100 μg daily. She wants guidance for when she develops a febrile illness. What is the most appropriate sick-day rule?

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Correct answer: E — Double the hydrocortisone dose for febrile illness

Sick-day rules for adrenal insufficiency: double the oral hydrocortisone dose during febrile illness, minor surgery, or physiological stress. Triple the dose for severe illness (vomiting, diarrhoea — unable to absorb oral). If unable to retain oral medication → IM hydrocortisone 100 mg (patients should have an emergency injection kit at home and know how to self-inject) then present to hospital. Wear a medical alert bracelet. Do NOT adjust fludrocortisone. Resume normal dosing when recovered.

Reference: Endocrine Society – 2016 – AI; ADSHG (Addison Disease Self-Help Group) 2024