Stress dose steroids

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Emergency corticosteroid suplementation in patients taking exogenous corticosteroids

Category Initial Subsequent
Minor procedure or surgery under local anesthesia (eg, inguinal hernia repair) No extra supplementation is necessary Continue normal dosing
Moderate surgical stress (eg, lower extremity revascularization, total joint replacement) 50 mg hydrocortisone IV 25 mg of hydrocortisone every eight hours for 24 hours. Resume usual dose thereafter.
Major surgical stress (eg, esophagogastrectomy, total proctocolectomy, open heart surgery) 100 mg hydrocortisone IV 50 mg every eight hours for 24 hours. Taper dose by half per day to maintenance level.