Stress dose steroids

Emergency corticosteroid suplementation in patients taking exogenous corticosteroids

Category Initial Subsequent
Minor procedure or surgery under local anesthesia (eg, inguinal hernia repair) No extra supplementation is necessary Continue normal dosing
Moderate surgical stress (eg, lower extremity revascularization, total joint replacement) 50 mg hydrocortisone IV 25 mg of hydrocortisone every eight hours for 24 hours. Resume usual dose thereafter.
Major surgical stress (eg, esophagogastrectomy, total proctocolectomy, open heart surgery) 100 mg hydrocortisone IV 50 mg every eight hours for 24 hours. Taper dose by half per day to maintenance level.

Pediatric Dose

“Emergent Intramuscular Dosing can be given if child is not tolerating oral medications” [1]or unable to get IV within 15 minutes. IM hydrocortisone sodium succinate (Solu-Cortef)

  • 25 mg for child 3 years and younger
  • 50 mg for children >3 yrs – 12 years
  • 100 mg for children 12 years and older.