Lincoln 101: Stress Dosing

Because Lincoln was on steroids for so long he is considered to be adrenal insufficient for the next six months - until his body can produce he natural cortisol he needs.

"During illness and stress, the body automatically increases the production of cortisol to react to the stress/illness so that the body can heal faster. With adrenal insufficiency, however, the body is not able to do this on its own. This then needs to be done artificially by increasing the amount of hydrocortisone your child is taking. Your doctor will recommend the appropriate stress dose. Stress dosing is given for any of the following reasons:

Fever 101°F or higher	Bronchitis
Diarrhea	Broken bone
Vomiting	Sprain or strain
Ear infection	Serious injury/accident
Strep throat	Surgical procedure
Pneumonia	Immunizations

When in doubt, call Children's Medical Center Endocrine Clinic at 937-641-3487 (or 937-641-3000 and ask for the on-call endocrinologist) for advice.

Stress dosing is done by giving the stress dose for any of the above reasons for as long as the problem exists. If, for instance, your child takes the stress dose and vomits within 30 minutes, give the stress dose again. If he/she vomits again, he/she will need to get a hydrocortisone injection in the muscle. This is called Solu-Cortefand your doctor will tell you your child’s dose. Once your child gets this injection, it is important to take him/her to the emergency room within 4 hours for medical treatment. Tell the emergency room doctors that your child has adrenal insufficiency and what medicine he/she is taking and at what doses. You will need to discuss with your child’s school how they intend to handle emergency situations requiring the Solu-Cortef injection. They may call 911 and have the emergency personnel give the injection and transport your child to the hospital. Always make sure that you have an up-to-date Solu-Cortef kit. The date is stamped on the vial’s manufacturer label, not the prescription label."