Fludocortisone Use in CIRCI

Guideline Recommendations

• The Society of Critical Care Medicine and European Society of Intensive Care Medicine guidelines suggest using IV hydrocortisone <400 mg/day for ≥3 days in patients with vasopressor-dependent septic shock, but do not mandate mineralocorticoid supplementation, according to the 2017 guidelines 1
• The European Society of Intensive Care Medicine does not recommend routine fludrocortisone use in septic shock, as stated in the 2017 guidelines 1

Mineralocorticoid Replacement

• Fludrocortisone is not indicated in primary adrenal insufficiency management during acute adrenal crisis in CIRCI, as stated by the Journal of Internal Medicine in 2014 2
• IV hydrocortisone 100 mg every 6-8 hours provides adequate mineralocorticoid effect at these high doses, during acute crisis, according to the Journal of Internal Medicine in 2014 2