Can Hydrocortisone Be Dissolved in 5% Dextrose?
Yes, hydrocortisone can be safely dissolved in 5% dextrose for intravenous infusion. 1
FDA-Approved Preparation
The FDA drug label explicitly states that after reconstituting hydrocortisone powder with bacteriostatic water, the solution may be added to 100 to 1000 mL of 5% dextrose in water for intravenous infusion. 1
Specific Preparation Instructions
- Reconstitute the hydrocortisone vial by adding ≤2 mL of Bacteriostatic Water for Injection. 1
- Add the reconstituted solution to 100–1000 mL of 5% dextrose in water (or isotonic saline, or 5% dextrose in isotonic saline if the patient is not sodium-restricted). 1
- Stability: Solutions remain stable for at least 4 hours after preparation and may be administered directly or by IV piggyback. 1
Clinical Context for Continuous Infusion
Multiple guidelines recommend continuous infusion of hydrocortisone 200 mg over 24 hours in 5% dextrose or saline for:
- Peri-operative stress coverage in patients with adrenal insufficiency or chronic steroid use (≥5 mg prednisolone-equivalent for ≥4 weeks). 2
- Septic shock when vasopressor therapy fails to achieve hemodynamic stability. 3
- Major surgery requiring general or regional anesthesia in patients with primary or secondary adrenal insufficiency. 2
Dosing Volumes
- For 100 mg hydrocortisone, add to 100–1000 mL of 5% dextrose. 1
- For 250 mg, add to 250–1000 mL. 1
- For 500 mg, add to 500–1000 mL. 1
- For 1000 mg, add to 1000 mL. 1
- In cases requiring small fluid volumes, 100–3000 mg may be added to 50 mL of diluent. 1
Alternative Diluents
If sodium restriction is not required, hydrocortisone may also be dissolved in:
Common Pitfall
- Do not use dextrose solutions in patients on strict sodium restriction without considering the alternative of isotonic saline alone. 1
- Ensure reconstitution first: The powder must be dissolved in a small volume of bacteriostatic water before adding to the larger dextrose bag. 1
Supporting Evidence from Clinical Practice
One study demonstrated that adding low-dose hydrocortisone (10 mg/L) to 10% dextrose in half-strength normal saline significantly reduced thrombophlebitis episodes during peripheral IV nutrition. 4 This supports the compatibility and safety of hydrocortisone in dextrose-containing solutions.