Situtation

 Increase in dose

Duration 

Emergency? 

Cold without fever 

 none

Fever, flu, infection        

double dose    

duration of illness

see GP after 48 hours

Vomiting > once, diarrhoea and severe illness

Emergency 100mg injection if extra dose of 10-20mg cannot be kept down

restart usual dose once stable

Phone GP or go to A&E. Administer injection prior to this if emergency pack available (but still seek help)

Minor surgical procedure e.g. tooth extraction    

20mg hydrocortisone before procedure

resume on usual dose immediately afterward

Minor operation e.g. hernia repair 

100mg im every 6 hours for 24 hours 

 resume on usual dose immediately afterward

Major operation e.g. abdomen or chest

100mg im injection every 6 hours for 24 -72 hours and eating and drinking

reduce rapidly to usual dose

tell the surgeon and anaesthetist before the operation

Pituitary surgery     

see proforma 

see proforma 

Endoscopy

Double the dose the day before during bowel prep. For colonoscopy 100mg im before procedure

take usual dose on the morning of the procedure

drink lots of water to prevent dehydration. Inform your doctor.

Cystoscopy        

Double dose on the day of procedure.

resume as normal        

inform your doctor.

Severe shock e.g. bereavment or road traffic accident

20mg as tablet or 100mg intramuscular injection

See GP or hospital for further advice

Sudden and severe shock may be classed as an emergency - seek advice

Long haul flight > 12 hours

double dose on the day of the flight

extra dose every 6-8 hours when the day is legnthened. Usual regimen in timing with sleep / wake cycle when day is shortened.

Speak to your consultant before travel.*

General stress, exams etc

 not usually required

ask GP if concerned