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Stress Dose Steroids

Griffin Bullock

Primary Options

  • Dexamethasone 4mg IV: does not affect cortisol assays, ideal if diagnosis uncertain
  • Hydrocortisone 100mg IV bolus then 50mg q8h until stable: greater mineralocorticoid activity. Ideal if adrenal insufficiency known/confirmed or if hyperkalemic (K>6.0)

When to Use

  • Concern for adrenal crisis
  • Pts with known adrenal insufficiency:
    • Minor Illness: ↑ dose x3 for 3 d or until clinically improved & acute stress resolved
  • Surgery: dependent on severity of operation
    • Minor (e.g. hernia repair): hydrocortisone 25mg for 1 day
    • Moderate (e.g. cholecystectomy): 50-75mg day of surgery and post-op day 1
    • Major (e.g. CABG): 100-150mg daily 2-3 days (would consult endocrine)
  • Trauma, critical illness, or unclear give stress dose