In this section
Intravenous fluid requirements
Adrenal insufficiency: steroid replacement before and after surgery or procedure requiring GA
An adrenal crisis is a physiological event caused by an acute relative insufficiency of adrenal hormones. It may be precipitated by physiological stress in a susceptible patient. It should be considered in patients who have a history of:
Adrenal crisis may also be the first presentation of underlying adrenal insufficiency or there may be a history suggestive of chronic hypoadrenalism.
investigations if first presentation (prior to steroid administration if possible):
Unstable/ in crisis or unwell (vomiting/diarrhoea, drowsy)
1. Steroid replacement
Recommended doses of 'Stress' Hydrocortisone (given IM or IV) by age:
*Note: some centres use continuous hydrocortisone infusions instead of intermittent dosing. This should be done under the guidance of the local endocrinology team.
2. Intravenous fluids
or moderate to severe dehydration:
or no dehydration:
3. Treat hypoglycaemia
Hypoglycaemia is common in infants and small children with adrenal insufficiency.
This usually normalises with fluid, electrolyte and steroid replacement.
5. Precipitating illness/injury
Identify and treat the illness or injury that precipitated the adrenal crisis.
Children with known adrenal insufficiency will have an individualised sick day management plan. This should be followed in the first instance. The following guidance is for when there is no sick day plan available.
Moderate illness or injury and/or fever >38 and tolerating oral intake and medicines
Vomiting and diarrhoea
For example, respiratory or ear infection with no more than low grade fever
<38, looks well, able to tolerate oral intake and no need for antibiotics.
Please see guideline for
stress dosing pre and perioperatively.
In all cases of adrenal insufficiency
For emergency advice and paediatric or neonatal ICU transfers, call
the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137
Recovering from illness
Information for parents: Kids health info fact sheet “
Adrenal Crisis Prevention”
Last Updated August, 2019