II. Protocol: Stress Dose Steroid
- Indication: Acute severe illness (critically ill such as Septic Shock)
- Serum Cortisol <15 to 34 mcg/dl
- Cortisol <9 after Corticotropin Stimulation Test
- Management
- Hydrocortisone
- Adults: 50 mg IV or IM q6 hours (or 3x the chronic dose)
- Children: 1 to 2 mg/kg IV every 8 hours
- Consider adding fludricortisone 50 mcg daily for 7 days
- Taper stress dosing over 10-14 days
- Hydrocortisone
III. Protocol: Perioperative Corticosteroids
- Indications: Primary or secondary Adrenal Insufficiency
- Hypothalamic pituitary axis suppression with chronic Corticosteroids within 3-12 months of surgery
- Predisone 20 mg for at least 3 weeks or
- Prednisone 5 mg daily longterm
- Hypothalamic pituitary axis suppression with chronic Corticosteroids within 3-12 months of surgery
- Minor procedure not requiring sedation (doses for day of surgery)
- Hydrocortisone 25 mg IV or
- Methylprednisolone 5 mg IV
- Moderate procedure requiring sedation
- Initial (day of surgery)
- Hydrocortisone 50-75 mg IV or
- Methylprednisolone 10-15 mg IV
- Next
- Hydrocortisone 25 mg IV every 8 hours for 24 to 48 hours
- Methylprednisolone tapered over 1-2 days
- Initial (day of surgery)
-
High Risk Surgery
- Initial (day of surgery)
- Hydrocortisone 100-150 mg IV or
- Methylprednisolone 20-30 mg IV
- Next
- Hydrocortisone 50 mg IV every 8 hours for 24 to 48 hours or
- Methylprednisolone tapered over 1-3 days
- Initial (day of surgery)
IV. References
- Dummer (2009) Perioperative Guidelines
- Fraboni (2012) Board Review Express, San Jose
- Coursin (2002) JAMA 287(2):236-40 [PubMed]