II. Indications
- Acute Adrenal Insufficiency
- Refractory Septic Shock adjunct
- Acute, new onset Ulcerative Colitis or Regional Enteritis
- Autoimmune Hemolytic Anemia
- Immune Thrombocytopenic Purpura
- Leukemia and Lymphoma (not before diagnosis)
- Acute Systemic Lupus Erythematosus or Rheumatoid Arthritis
III. Mechanism
- Low potency
- Short acting
- Low antiinflammatory activity
- High mineralcorticoid activity (effect on Sodium and water retention)
- Preferred replacement in Adrenal Insufficiency
IV. Dosing: Miscellaneous
-
General
- Parenteral: 100 to 150 mg IV/IM q2-6 hours prn
- Oral: 20 to 240 mg/day PO in divided dosing
-
Adrenal Insufficiency
- Adults: 100 mg IV every 8 hours (or Dexamethasone 4 mg IV)
- Children: 1 to 2 mg/kg IV every 8 hours
- Newborns: 12.5 mg IV
- Infants and young children: 25 mg IV
- School Aged Children: 50 mg IV
- Teens (same as adult dosing): 100 mg IV
V. Dosing: Stress Dose Steroid
- See Perioperative Corticosteroid
- Indication: Acute severe illness (critically ill such as Septic Shock)
- Serum Cortisol <15 to 34 mcg/dl
- Cortisol <9 after Corticotropin Stimulation Test
- Hydrocortisone
- Adults: 50 mg IV or IM q6 hours (or 3x the chronic dose)
- Children: 1 to 2 mg/kg IV every 8 hours
- Consider adding fludricortisone 50 mcg daily for 7 days (for additional mineralcorticoid activity )
- Taper stress dosing over 10-14 days
VI. Adverse Effects
VII. References
- LoVecchio (2022) Crit Dec Emerg Med 36(11): 32
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Related Studies
| hydrocortisone (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| HYDROCORTISONE 0.5% CREAM | Generic OTC | $0.05 per gram |
| HYDROCORTISONE 1% CREAM | Generic | $0.10 per gram |
| HYDROCORTISONE 1% OINTMENT | Generic | $0.15 per gram |
| HYDROCORTISONE 10 MG TABLET | Generic | $0.29 each |
| HYDROCORTISONE 100 MG/60 ML | Generic | $0.16 per ml |
| HYDROCORTISONE 2.5% CREAM | Generic | $0.11 per gram |
| HYDROCORTISONE 2.5% LOTION | Generic | $0.19 per ml |
| HYDROCORTISONE 2.5% OINTMENT | Generic | $0.10 per gram |
| HYDROCORTISONE 20 MG TABLET | Generic | $0.38 each |
| HYDROCORTISONE 5 MG TABLET | Generic | $0.17 each |
| HYDROCORTISONE BUTY 0.1% CREAM | Generic | $2.04 per gram |
| HYDROCORTISONE VAL 0.2% CREAM | Generic | $0.60 per gram |
| HYDROCORTISONE VAL 0.2% OINTMT | Generic | $3.20 per gram |
| HYDROCORTISONE-ALOE 1% CREAM | Generic OTC | $0.06 per gram |