Adrenal insufficiency protocol for children who require surgery, procedure or dental extractions

Summary

• Anaesthetic usually under 20mins duration (up to 1 hour)
• Examples include endoscopy, jejunal biopsy, adenotonsillectomy, grommet insertion and dental extraction
• Usually able to eat and drink within 4 hours post-procedure

Steroid cover

1. At induction, patient should be have IV bolus of hydrocortisone.
   
2. Post-operatively, give double the largest usual hydrocortisone dose when able to tolerate orally and  administer three times daily for 48 hrs.
   (eg if normally on 10mg morning, 10mg afternoon and 5mg evening, then give 20mg threes times a day)
   • if oral hydrocortisone not tolerated, commence IV hydrocortisone infusion

Steroid cover

1. Patient should have an IV bolus of hydrocortisone at induction of anaesthesia and then commenced onto hydrocortisone infusion in theatre as below.
   
2. Infusion should continue until patient is well and able to tolerate oral hydrocortisone.
3. Give double the largest usual hydrocortisone dose and if tolerated discontinue infusion 1-2 hours later.
4. Continue with doubled largest dose hydrocortisone and  administer three times daily for 48 hrs
   (eg if normally on 10mg morning, 10mg afternoon and 5mg evening, then give 20mg threes times a day)

Any concerns contact Endocrine Team

DO NOT DISCHARGE HOME without discussing with endocrine team