Hydrocortisone 100mg Dilution for Intravenous Administration
Dilute hydrocortisone 100mg with no more than 2 mL of either sterile water for injection or 0.9% sodium chloride (normal saline) for direct IV or IM injection. 1
Direct IV/IM Injection Preparation
- Add a maximum of 2 mL of diluent (either Bacteriostatic Water for Injection or Bacteriostatic Sodium Chloride Injection) to the 100mg vial 1
- Gently agitate to dissolve the powder completely 1
- This concentrated solution can be administered directly intravenously or intramuscularly without further dilution 1
IV Infusion Preparation (When Continuous Infusion Required)
For continuous infusion, first reconstitute the 100mg vial with no more than 2 mL of Bacteriostatic Water for Injection, then add this solution to 100-1000 mL of compatible IV fluid. 1
Compatible IV Fluids:
- 5% dextrose in water 1
- 0.9% sodium chloride (isotonic saline) 1
- 5% dextrose in isotonic saline (if patient not on sodium restriction) 1
Stability Considerations:
- Reconstituted solutions remain stable for at least 4 hours 1
- The final pH ranges from 7-8 after reconstitution 1
- The 100mg solution has an osmolarity of 0.36 osmolar 1
Clinical Context for 100mg Dosing
The 100mg dose is specifically recommended in multiple clinical scenarios:
- Perioperative stress coverage: 100mg IV at induction of anesthesia for patients with adrenal insufficiency 2
- Labor and delivery: 100mg IV at onset of active labor 2
- Bowel procedures: 100mg IV or IM at procedure start 2
- Major surgery: 100mg IV bolus followed by continuous infusion of 200mg/24h 2
Important Caveats
- Never exceed 2 mL of diluent for the initial reconstitution of the 100mg vial to ensure proper dissolution and concentration 1
- For small volume administration where fluid restriction is critical, 100mg can be added to as little as 50 mL of compatible diluent 1
- Hydrocortisone demonstrates Y-site physical compatibility with multiple critical care medications including epinephrine, norepinephrine, and various antibiotics when diluted in 0.9% sodium chloride 3
- The choice between water for injection versus saline for initial reconstitution does not affect stability or efficacy—both are FDA-approved diluents 1