Pharm

Hydrocortisone

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Hydrocortisone, Cortef

  • See Also
  1. Systemic Corticosteroid
  2. Stress Dose Steroid
  3. Topical Corticosteroid
  • Indications
  1. Acute Adrenal Insufficiency
  2. Refractory Septic Shock adjunct
  3. Acute, new onset Ulcerative Colitis or Regional Enteritis
  4. Autoimmune Hemolytic Anemia
  5. Immune Thrombocytopenic Purpura
  6. Leukemia and Lymphoma (not before diagnosis)
  7. Acute Systemic Lupus Erythematosus or Rheumatoid Arthritis
  • Mechanism
  1. Low potency
  2. Short acting
  3. Low antiinflammatory activity
  4. High mineralcorticoid activity (effect on Sodium and water retention)
  5. Preferred replacement in Adrenal Insufficiency
  • Dosing
  • Miscellaneous
  1. General
    1. Parenteral: 100 to 150 mg IV/IM q2-6 hours prn
    2. Oral: 20 to 240 mg/day PO in divided dosing
  2. Adrenal Insufficiency
    1. Adults: 100 mg IV every 8 hours (or Dexamethasone 4 mg IV)
    2. Children: 1 to 2 mg/kg IV every 8 hours
      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
  1. See Perioperative Corticosteroid
  2. 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
  3. 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
  4. Consider adding fludricortisone 50 mcg daily for 7 days (for additional mineralcorticoid activity )
  5. Taper stress dosing over 10-14 days
  • Adverse Effects
  1. See Systemic Corticosteroid
  • References
  1. LoVecchio (2022) Crit Dec Emerg Med 36(11): 32