Hydrocortisone replacement patient information

Patient Information
 
What is Hydrocortisone?

Hydrocortisone is a steriod hormone produced by the adrenal gland.  It regulates many of the bodies functions and is essential for life.

Hydrocortisone is taken as a replacement for the natural hormone where this is deficient, either because of pituitary deficieny of ACTH (the hormone that stimulates the production of hydrocortisone by the adrenal gland) or failure of hydrocortisone production by the adrenal gland.
 
How do I take it?

A common dose is 15-20mg orally split over two or three times daily, and depending on your individual Endocrinologist's recommendations, e.g., 10mg before rising, 5mg at mid-day and 5mg at 4 pm.

Can I take it once daily?

No. Hydrocortisone has a short half life, and so needs to be administered twice or thrice daily. Prednisolone has a longer half life and can be used once daily.

When would I need to take more hydrocortisone?

If you become ill then the body would naturally increase the output of steroid from your adrenals.  Therefore if you are taking replacement steriod (hydrocortisone) it is essential to mimic the natural response by increasing yoru dose appropriately.

How can I let others know I take replacement hydrocortisone?

When you are prescribed your medication you will be given a 'blue steroid card' from the hospital to carry.  You should also purchase and wear a medical necklace or bracelet, such as MedicAlert, to show your Cortisol replacement therapy. 
 
Emergency Injections - should I have these at home?
It is advisable for all patients on hydrocortisone replacement to have a 100mg injection pack at home and for them or their partners to be taught how to administer it.  If you don't have one of these already, you can ask your GP or endocrinologist if they will prescribe this for you.  Please check regularly that these preparations are not expired.  Some endocrine clinics will help to show you how to inject in an emergency.
 

When do I know that I would need an emergency injection?

If you cannot absorb your tablets, or your usual replacement wasn't sufficient for an acute shock or illness, then gradually or perhaps quite quickly you would feel weak, sickly and light-headed.


Recommendations for changes in oral dose 'The Sick Rules'
If you become unwell you should take additional hydrocortisone. The amount depends on how unwell you are and the type of illness. The pituitary foundation provides some sensible examples:
 
If a patient is unwell they should take additional hydrocortisone. The amount depends on how unwell they are and the type of illness. Some examples:
 

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

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 

 

How do I cope if I'm travelling away from home?
You should travel with a 100mg injection kit  in case of emergency.  This injection should be placed in a small cool bag, labelled with your name and kept with you at all times during your journey. You should ask your GP or endocrinologist for a letter about your injection kit, medication and your doses prescribed.  This letter is essential to travel through security checks and will be helpful should you become unwell and have to see a doctor. It is wise to take an extra two weeks supply of hydrocortisone tablets with you in case you need to increase your usual dose whilst away.  All medication should be kept in your hand luggage.
 
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