23
Examples Suggested regimen
Severe intercurrent
illness, for example:
• Persistent vomiting or
diarrhea from gastro-
intestinal illness.
• Infection requiring
hospital admission or
I.V. antibiotics (e.g.,
sepsis).
• Acute trauma
resulting in significant
blood loss or hospital
admission.
For patients with persistent vomiting or diarrhea who are well
enough to remain out of hospital: Hydrocortisone 100 mg I.M.
injection immediately, which can be repeated aer 6 hours if
needed. If symptoms do not resolve or hemodynamic instability
develops, admit to hospital for I.V. urgent glucocorticoid and
fluid administration.
Patients requiring hospital admission: Hydrocortisone 100 mg
I.V. bolus or I.M. injection immediately, followed by immediate
initiation of a continuous infusion of hydrocortisone 200 mg over
24 h. If a continuous infusion is not feasible, give hydrocortisone
50 mg I.V. boluses every 6 hours. e duration and dose of the
glucocorticoid regimen thereaer must be individualized based
on the stressor type and the patient's clinical status.
Surgery or any
procedure requiring
general or regional
anesthesia with
anticipated short
recovery time and no
nil by mouth
Intra-operative regimen: Hydrocortisone 100 mg I.V. bolus
at induction, followed by immediate initiation of a continuous
infusion of hydrocortisone 200 mg over 24 h. If a continuous
infusion is not feasible, give hydrocortisone 50 mg I.V. boluses
every 6 hours.
Postoperative regimen: Resume oral glucocorticoids at an
increased dose for 48 h (e.g., hydrocortisone 40 mg/daily in three
divided doses; prednisone 10 mg/daily in one or two divided
doses; dexamethasone 1 mg once daily) and then resume the
pre-surgical dose. In case of post-operative complications (e.g.,
significant pain, infections), maintain an increased oral dose or
give stress-dose glucocorticoids I.V. as clinically appropriate.
Surgery (including
cesarean section) or any
procedure requiring
general or regional
anesthesia with nil by
mouth or expected long
recovery time
Intra-operative regimen: Hydrocortisone 100 mg I.V. bolus
at induction, followed by immediate initiation of a continuous
infusion of hydrocortisone 200 mg over 24 h. If a continuous
infusion is not feasible, give hydrocortisone 50 mg I.V. boluses
every 6 hours.
Postoperative regimen: Continuous infusion of hydrocortisone
200 mg over 24 h while the patient is nil by mouth. If a continuous
infusion is not feasible, give hydrocortisone 50 mg I.V. boluses
every 6 hours. If the post-operative period is uncomplicated
and once the patient can eat, resume oral glucocorticoids at an
increased dose for 48 h (e.g., hydrocortisone 40 mg/daily in three
divided doses; prednisone 10 mg/daily in one or two divided
doses; dexamethasone 1 mg once daily) and then resume the
pre-surgical dose. In case of post-operative complications (e.g.,
significant pain, infections), maintain an increased oral dose or
give stress-dose glucocorticoids I.V. as clinically appropriate.
Labor and vaginal
delivery
Hydrocortisone 100 mg I.V. bolus at onset of labor, followed by
immediate initiation of a continuous infusion of hydrocortisone
200 mg over 24 h. If a continuous infusion is not feasible, give
hydrocortisone 50 mg I.V. boluses every 6 hours.
