Stress-dose steroids
Formal Definition
Supraphysiologic glucocorticoid doses administered to patients with known or suspected adrenal insufficiency during physiologic stress (surgery, critical illness, trauma, or severe infection) to prevent adrenal crisis; typically 50–100 mg hydrocortisone IV every 8 hours, with tapering to maintenance once stress resolves.
How It's Used on the Ward
"Stress-dose the patient" or "they need stress dosing" — the preemptive corticosteroid boost given to patients on chronic steroids before or during major stressors.
Example
""Patient on prednisone 10 mg daily for PMR going to the OR for bowel resection: needs stress-dose steroids perioperatively. Starting hydrocortisone 100 mg IV now, 50 mg q8h during surgery and first 24 hours post-op, then taper back to home dose over 2 days if course uncomplicated.""
Clinical Context
Who needs stress-dosing? Patients on ≥5 mg prednisone/day for >3 weeks (or equivalent); those with pituitary/hypothalamic disease; known Addison disease. Stress dose tiers: minor procedure (dental) = 25 mg hydrocortisone day of; moderate surgical stress = 50 mg hydrocortisone 8h for 1–2 days; major surgery/critical illness = 100 mg bolus then 50 mg q8h for 2–3 days. Risk of not giving: adrenal crisis. Risk of giving: hyperglycemia, infection, delayed healing. When uncertain, give it — adrenal crisis is worse than a day of steroids.
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