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Sick day management – CAH — RACP Paediatrics MCQ

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EasyEndocrineSick day management – CAHRACP Paediatrics

A 5-year-old with CAH has a fever of 38.5°C from an upper respiratory tract infection. He is well enough to take oral fluids and medications. What is the most appropriate management of his hydrocortisone?

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Correct answer: D — Oral hydrocortisone stress dosing

For minor febrile illness (temperature ≥38°C) in a child with adrenal insufficiency who can tolerate oral medications, oral hydrocortisone should be doubled (stress dosing) or tripled depending on fever severity. Parents should be educated on sick-day rules. If vomiting occurs or the child deteriorates, IM hydrocortisone and ED presentation are required.

Reference: RCH Melbourne – 2023 – Adrenal Crisis CPG; RACP Paediatric Curriculum – Endocrine