Stress Dose Steroids

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