Injectable Hydrocortisone Dosing in Acute Situations

Dosing by Clinical Scenario

The American College of Physicians recommends an initial dose of 100 mg IV bolus of hydrocortisone given immediately in cases of adrenal crisis, with maintenance doses of 100-300 mg/day as continuous infusion or divided into doses every 6 hours 2
For patients undergoing major surgery with long recovery, the American College of Surgeons recommends 100 mg hydrocortisone IM just before anesthesia, then 100 mg IM every 6 hours until able to eat and drink 1, 3
In cases of septic shock, the Surviving Sepsis Campaign recommends 200 mg/day of hydrocortisone, preferably as continuous infusion, only indicated in patients who don't achieve hemodynamic stability after adequate fluid resuscitation and vasopressor therapy 4
For perioperative management in patients on chronic steroids, the World Journal of Emergency Surgery suggests that in case of hypotension related to adrenal crisis during surgery, administer 100 mg hydrocortisone IV, followed by 50 mg hydrocortisone every 6 hours 5

The Endocrine Society recommends that for patients with adrenal insufficiency, doses should be increased during illness, injury, or other stressful situations 1, 3

The American College of Emergency Physicians warns that delayed administration of hydrocortisone in adrenal crisis can be fatal; treatment should not be delayed by diagnostic procedures 2
The World Journal of Emergency Surgery notes that patients on chronic steroid therapy have higher rates of surgical complications, including anastomotic leaks and wound dehiscence 6
In patients with unexplained hypotension during surgery that is unresponsive to fluids, the World Journal of Emergency Surgery recommends considering adrenal insufficiency and administering 100 mg hydrocortisone IV 5