From the Guidelines
Stress dose steroids should not be used routinely in neutropenic patients, but may be considered in specific situations such as adrenal insufficiency or septic shock unresponsive to fluids and vasopressors, with careful monitoring for infection and adjustment of dosing as needed. The use of stress dose steroids in neutropenic patients is a complex issue, and the decision to use them should be made on a case-by-case basis, taking into account the individual patient's risk factors and clinical status. According to the most recent and highest quality study 1, hydrocortisone 50-100 mg intravenously every 6-8 hours may be used as a stress dose in patients with adrenal insufficiency or those on chronic steroid therapy who develop critical illness.
Some key points to consider when using stress dose steroids in neutropenic patients include:
- The potential for steroids to worsen immunosuppression and mask signs of infection, potentially leading to delayed diagnosis of infectious complications 1
- The importance of close monitoring for infection, including regular vital signs, daily physical examinations, and a low threshold for obtaining cultures and initiating empiric antimicrobial therapy
- The need for careful adjustment of dosing and tapering of steroids to minimize the risk of adverse effects and optimize outcomes
- The consideration of alternative treatments, such as fludrocortisone, in patients with primary adrenal insufficiency 1
In terms of specific dosing recommendations, hydrocortisone 50-100 mg intravenously every 6-8 hours may be used as a stress dose in patients with adrenal insufficiency or those on chronic steroid therapy who develop critical illness 1. However, the dosing and duration of therapy should be individualized based on the patient's clinical status and response to treatment.
Overall, the use of stress dose steroids in neutropenic patients requires careful consideration of the potential benefits and risks, and should be guided by the most recent and highest quality evidence available 1.
From the Research
Stress Dose Steroids in Neutropenic Patients
- The use of stress dose steroids in neutropenic patients is not directly addressed in the provided studies, however, the administration of glucocorticosteroids such as hydrocortisone and prednisone can increase the blood neutrophil count 2.
- In normal subjects, the upper three doses of both hydrocortisone and prednisone increased the blood neutrophil count by approximately 4,000 cells/mm3 2.
- The neutrophilia occurring after hydrocortisone and/or prednisone was compared with that observed after endotoxin and etiocholanolone in normal subjects and patients with various conditions, and the results were similar for all agents 2.
- While the provided studies do not specifically discuss the recommended use of stress dose steroids in patients with neutropenia, they do highlight the importance of managing neutropenia and preventing neutropenic sepsis in patients receiving anticancer therapy 3, 4, 5, 6.
- Nurses play a crucial role in recognizing the signs and symptoms of neutropenic sepsis and ensuring early diagnosis and treatment, and there are evidence-based pathways for the treatment of patients with neutropenic sepsis 6.