1. Correction of hypotension and electrolyte imbalances. |
|
2. Hydrocortisone replacement therapy as soon as blood samples have been collected for diagnosis |
|
3. Treatment of the underlying problem that precipitated the crisis |
Procedure or clinical condition | Dosing of glucocorticoids |
---|---|
Minor surgical procedure or illness
| Before the procedure, 25 mg hydrocortisone orally or intravenously in addition to the normal replacement dose. On the days of illness, double the normal replacement dose. |
Moderate surgical procedure or illness
| Before the procedure, 50 mg hydrocortisone or 10 mg methylprednisolone intravenously in addition to the normal replacement dose. The dose should be tapered over 1-2 days to the usual dose. On the days of illness, 50 mg hydrocortisone orally, intramuscularly or intravenously divided into 2 doses in addition to the normal replacement dose. The dose should be tapered to the usual dose according to recovery from the illness. |
Major procedure or illness
| On the day of the procedure, 150 mg hydrocortisone or 30 mg methylprednisolone intravenously divided into 2-3 doses in addition to the normal replacement dose. The dose should be tapered over 2 days to the usual dose depending on recovery. On the days of illness, 100 mg hydrocortisone intravenously divided into 2 doses in addition to the normal replacement dose. The dose should be tapered to the usual dose according to recovery from the illness. |
Critical illness
| 100 mg Hydrocortisone intravenously, followed by 50 mg intravenously every 6 hours. Gradual tapering off |