Hydrocortisone Stress Doses Recommendation For Patients on Long Term Hydrocortisone Therapy Undergoing General Anesthesia/ Surgery

Initial hydrocortisone IV bolus at the time of induction of anesthesia

• < 3 years – IV hydrocortisone 25mg stat
• 3-10 years – IV hydrocortisone 50 mg stat
• >10 years or >40 Kg- IV hydrocortisone 100 mg stat
  

This should be followed by
< 3 years – IV hydrocortisone 25mg/day divided into 6 hourly doses
3-10 years – V hydrocortisone 75 mg/day divided into 6 hourly doses
10 years or > 40kg – IV hydrocortisone 100mg/day in 6 hourly doses

Till the patient is fully recovered
Once the patient starts taking orally :
Give double the dose of his or her usual oral hydrocortisone for the next 48 hours. (If the patient has fever, this double dose is to be continued until fever-free for 24 hrs)
Start the usual hydrocortisone dose which the patient is already on after 48 hours
Monitor blood pressure, hydration, and CBS

Continue the usual dose of fludrocortisone

Endocrine unit. Lady Ridgeway Hospital for Children. Colombo.
Ref-Emergency Instructions Treatment: CARES foundation)