Hydrocortisone

See Systemic Corticosteroid
Preferred replacement in Adrenal Insufficiency (both Glucocorticoid and mineralcorticoid activity)
Hydrocortisone is identical chemically to the Cortisol synthesized by the Adrenal Gland
Short-acting Corticosteroid
Weak mineralcorticoid activity

Adult
1. Parenteral: 100 to 150 mg IV/IM every 2 to 6 hours prn
2. Oral: 20 to 240 mg/day orally in divided dosing
Child (not standardized in general outside of specific indications)
1. Oral or IV: 0.5 to 8 mg/kg/day divided every 6 to 8 hours

See Acute Adrenal Insufficiency
Adults
1. Primary: 15 to 25 mg/day orally every 8 to 12 hours (give at least 50% of the dose in the AM)
2. Acute Crisis: 100 mg IV every 8 hours (or Dexamethasone 4 mg IV)
Children
1. Primary: 8 mg/m2 divided every 8 to 12 hours
2. Acute Crisis
  1. Calculated
    1. Weight: 1 to 2 mg/kg IV every 8 hours
    2. BSA: 50 to 100 mg/m2 IV load then 50 to 100 mg/m2/day divided every 6 hours
  2. Age
    1. Newborns: 12.5 mg IV
    2. Infants and young children: 25 mg IV
    3. School Aged Children: 50 mg IV
    4. Teens (same as adult dosing): 100 mg IV

See Stress Dose Steroid
See Perioperative Corticosteroid
Indication: Acute severe illness (critically ill such as Septic Shock)
1. Serum Cortisol <15 to 34 mcg/dl
2. Cortisol <9 after Corticotropin Stimulation Test
Hydrocortisone
1. Adults: 50 mg IV or IM q6 hours (or 3x the chronic dose)
2. 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