What is the typical dose of injectable hydrocortisone (HC) for acute situations?

Injectable Hydrocortisone Dosing in Acute Situations

The typical dose of injectable hydrocortisone for acute situations is 100 mg administered intravenously or intramuscularly, which may be repeated every 6 hours depending on the clinical scenario. 1

Dosing by Clinical Scenario

Adrenal Crisis

• Initial dose: 100 mg IV bolus given immediately 1
• Maintenance: 100-300 mg/day as continuous infusion or divided into doses every 6 hours 1
• Fluid resuscitation: 3-4 L isotonic saline or 5% dextrose in isotonic saline with initial rate of approximately 1 L/hour 1
• Continue IV hydrocortisone until patient stabilizes, then taper to oral therapy over 1-3 days 1

Surgical Procedures

• Major surgery with long recovery: 100 mg hydrocortisone IM just before anesthesia, then 100 mg IM every 6 hours until able to eat and drink 1
• Major surgery with rapid recovery: 100 mg hydrocortisone IM just before anesthesia, then 100 mg IM every 6 hours for 24-48 hours 1
• Minor surgery and major dental surgery: 100 mg hydrocortisone IM just before anesthesia 1
• Invasive procedures: 100 mg hydrocortisone IM just before start of procedure 1

Septic Shock

• 200 mg/day of hydrocortisone, preferably as continuous infusion 2
• Only indicated in patients with septic shock who don't achieve hemodynamic stability after adequate fluid resuscitation and vasopressor therapy 2
• Should be tapered gradually when vasopressors are no longer required 2

Perioperative Management in Patients on Chronic Steroids

• In case of hypotension related to adrenal crisis during surgery, administer 100 mg hydrocortisone IV, followed by 50 mg hydrocortisone every 6 hours 1
• Recent evidence suggests that routine "push-dose steroids" may not be necessary for patients already on high-dose chronic steroid therapy 1

Administration Methods

• For emergency use, intravenous injection is the preferred method 3
• May be administered by IV injection over 30 seconds (100 mg) to 10 minutes (500 mg or more) 3
• Can also be administered by intramuscular injection when IV access is not available 3
• For IV infusion, prepare solution by adding no more than 2 mL of Bacteriostatic Water for Injection to the vial 3

Important Considerations

• High-dose corticosteroid therapy should generally be continued only until the patient's condition has stabilized, usually not beyond 48-72 hours 3
• When high-dose hydrocortisone therapy must be continued beyond 48-72 hours, hypernatremia may occur 3
• Dosage requirements are variable and must be individualized based on the disease being treated and the patient's response 3
• For patients with adrenal insufficiency, doses should be increased during illness, injury, or other stressful situations 1

Pitfalls and Caveats

• Delayed administration of hydrocortisone in adrenal crisis can be fatal; treatment should not be delayed by diagnostic procedures 1
• Patients on chronic steroid therapy have higher rates of surgical complications, including anastomotic leaks and wound dehiscence 1
• In patients with unexplained hypotension during surgery that is unresponsive to fluids, consider adrenal insufficiency and administer 100 mg hydrocortisone IV 1
• When reconstituted, hydrocortisone solutions should be inspected for particulate matter and discoloration prior to administration 3
• Physical incompatibilities may occur; SOLU-CORTEF should not be diluted or mixed with other solutions 3