Stress dose
# Stress dose

Perioperative stress dose 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.

## Stress doses

Emergency corticosteroid supplementation in patients taking exogenous corticosteroids:

| 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:

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