Stress Dose Steroids – Griffin Bullock
Primary Options
- Dexamethasone 4 mg IV: does not affect cortisol assays, ideal if diagnosis uncertain
- Hydrocortisone 100 mg IV bolus then 50 mg 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
- Patients with known adrenal insufficiency:
- Minor Illness: ↑ dose x3 for 3 d or until clinically improved/ acute stress/illness resolved
- Surgery: dependent on severity of operation
- Minor (e.g. hernia repair): hydrocortisone 25 mg for 1 day
- Moderate (e.g. cholecystectomy): 50-75 mg day of surgery and post-op day 1
- Major (e.g. CABG): 100-150 mg daily 2-3 days
- Trauma, critical illness, or unclear give stress dose
- Pregnancy: hydrocortisone 25 mg q6h during labor. If prolonged hydrocortisone 100 mg q6h at the time of delivery