Stress dose

Perioperative stress doses of steroids to mitigate this rare but potentially fatal complications of perioperative use of steroid such as full-blown adrenal crisis in the perioperative period due to the secondary adrenal insufficiency. Various exogenous steroid preparations are used for a wide range of indications.^[1]

Stress doses

Emergency corticosteroid supplementation in patients taking exogenous corticosteroids:^[2]

Category	Initial	Subsequent
Minor procedure or surgery under local anesthesia (e.g., inguinal hernia repair)	No extra supplementation is necessary	Continue normal dosing
Moderate surgical stress (e.g., 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 doses

Emergent intramuscular dosing can be given if child is not tolerating oral medications or unable to get IV within 15 minutes. IM hydrocortisone sodium succinate doses are:^[3]

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