A patient with adrenal insufficiency may require supplement corticosteroid therapy during times of stress. Coursin and Wood compiled a list of recommended corticosteroid dosages based on the magnitude of the clinical stressor. The authors are from the University of Wisconsin in Madison.
|
Stressor |
Magnitude |
|
inguinal hernia repair colonoscopy mild febrile illness mild-moderate nausea and vomiting gastroenteritis |
minor |
|
open cholecystectomy hemicolectomy significant febrile illness pneumonia severe gastroenteritis |
moderate |
|
major cardiothoracic surgery Whipple procedure liver resection pancreatitis |
severe |
|
sepsis-induced hypotension or shock |
critically ill |
Replacement guidelines:
(1) Patients receiving 5 mg per day or less of prednisolone should receive their normal daily replacement but do not require supplementation.
(2) Patients receiving more than 5 mg per day of prednisone should receive the dose in the following Table in addition to their maintenance therapy.
|
Stressor Magnitude |
Corticosteroid Dosage |
Dosing |
|
minor |
25 mg of hydrocortisone, OR 5 mg of methylprednisone intravenous |
intravenous on day of procedure only |
|
moderate |
50 – 75 mg of hydrocortisone, OR 10-15 mg of methyl-prednisone |
intravenous on day of procedure; taper quickly over 1-2 days to usual dose |
|
severe |
100 – 150 mg of hydrocortisone, OR 20-30 mg methylprednisolone |
intravenous on day of procedure; taper quickly over 1-2 days to usual dose |
|
critically ill |
50 – 100 mg hydrocortisone every 6-8 hours, OR 0.18 mg/kg/h as a continuous infusion plus 50 µg/d of fludrocortisone |
intravenous until shock resolves; may take several days to a week or more; then gradually taper, following vital signs and serum sodium |
where:
• Fludrocortisone = 9-alpha-fluorohydrocortisone (synthetic mineralocorticoid)
NOTE: Since a person may have more than one of the stressors present, it may be necessary to combine them to adjust dosage. One such method:
(1) each 2-3 minor stressors: equates to 1 moderate stressor
(2) each 2 moderate stressors: equates to 1 severe stressor
(3) each 2 severe stressors: equates to critically ill
Purpose: To determine the corticosteroid supplementation required by a patient with adrenal insufficiency based on the magnitude of clinical stressors.
Specialty: Endocrinology, Clinical Laboratory, Critical Care
Objective: dosage calculations
ICD-10: E27.4,
