Families on chronic corticosteroids need a clinician-written plan for fever, vomiting, injury, surgery and inability to take oral doses, plus emergency hydrocortisone instructions when prescribed.
What this means in real life
Stress-dose steroids replace the cortisol surge the body may not produce after chronic corticosteroid therapy. The required dose depends on the person’s daily steroid, body size and severity of stress: fever, significant injury, surgery, severe illness or vomiting may require different plans. This must be written by the prescriber; generic internet charts cannot account for every regimen.
If oral steroid cannot be kept down, emergency hydrocortisone may be needed when prescribed, followed by urgent medical assessment. Families and schools should know the injection location and technique. Symptoms of adrenal crisis include severe weakness, repeated vomiting, abdominal pain, confusion, dizziness, dehydration, low blood pressure or collapse.
Continue precautions during and sometimes after tapering until the team confirms adrenal recovery. Medical alert identification and an emergency letter reduce dangerous delays.
A practical checklist
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Keep individualized daily, moderate-stress and emergency instructions.
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Ensure current weight-based dosing and supplies.
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Train caregivers/school in emergency hydrocortisone if prescribed.
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Carry medical alert and emergency letter.
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Seek emergency care after injection or for crisis signs.
Questions to bring with you
Use these at the clinic, school meeting, equipment evaluation, program interview or benefits call. Write down the answers and who owns the next step.
- Which fever, injury or procedure requires which dose?
- What if the daily dose was vomited?
- When should hydrocortisone be injected?
- How long should stress dosing continue?
- When is adrenal testing needed after taper?
Important safety note
This topic can involve serious or immediate risk. Do not start, stop or change treatment from an online answer. Contact the Duchenne care team; use emergency services for urgent symptoms or danger.
Sources used for this guide
Direct links are included so families can check the original guidance and bring it to qualified professionals.
Content review: July 18, 2026. Medical labels, trials, benefits and programs can change after publication.
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