Taper hydrocortisone treatment when vasopressors no longer required.Continuous infusion is recommended over repetitive bolus injections as repetitive boluses have been shown to significantly increase blood glucose.Steroids should not be used in septic patients to prevent septic shock as there is a lack of evidence to support this.IV hydrocortisone should not be used if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability.Recommendations from the International Guidelines for Management of Severe Sepsis and Septic Shock 2016: gastrointestinal, respiratory, musculoskeletal, and hematologic. Uses: For use when oral therapy is not feasible it is used as a potent anti-inflammatory agent in managing disorders, diseases, and conditions affecting many organ systems including endocrine, dermatologic, ophthalmic, nervous. Patients should be closely monitored for signs requiring dose adjustments if therapy is to be stopped after more than a few days, it should be gradually withdrawn.Lower doses, including doses lower than recommended doses, may suffice in less severe disease doses in excess of recommended doses may be required in severe disease in life-threatening situations, doses exceeding multiples of the oral dose may be justified.Maintenance dose: After a favorable initial response, dose should be decreased in small amounts to the lowest dose that maintains an adequate clinical response if a positive response is not achieved after a reasonable period of time, alternative therapy should be sought. Initial dose: 100 mg to 500 mg IV or IM may repeat doses at intervals of 2, 4, or 6 hours as indicated by response and clinical indication.Initial dose: 20 mg to 240 mg orally per day.Use: For the treatment of adrenocortical insufficiency Usual Adult Dose for Anti-inflammatoryĭosing should be individualized on the basis of disease and patient response

Major surgery with anesthesia, trauma, delivery, or ICU care: 100 mg IV followed by 200 mg IV infusion over 24 hours (or 50 mg IV/IM every 6 hours for 24 hours).

Minor to moderate surgical stress: 25 to 75 mg per 24 hours for 1 to 2 days.

Not tolerating oral medication due to gastroenteritis or trauma: 100 mg IM.

Illness with fever: Double (fever greater than 100.4F ) or triple (fever greater than 102.2F ) oral hydrocortisone doses until recovery (usually 2 to 3 days) increase consumption of electrolyte-containing fluids as tolerated.

Surgery and other stress inducing situations will require supplemental doses.

Most patients with PAI will require mineralocorticoid supplementation.

Glucocorticoid replacement therapy should be adjusted based on clinical response.Fluid status should be managed according to protocols.Highest dose should be given in the morning, then 2 hours after lunch (2-dose/day regimen) or at lunch and afternoon (3-dose/day regimen)Īdjust dose according to severity of illness or magnitude of stressor.Management of Primary Adrenal Insufficiency (PAI):ġ5 mg to 25 mg orally in 2 or 3 divided doses per day Usual Adult Dose for Adrenocortical Insufficiencyġ00 mg IV followed by IV infusion of 200 mg over 24 hours OR 50 mg IV every 6 hours then 100 mg IV the following day

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