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Table 6 Recommendations for the management of AS

From: Adrenal suppression: A practical guide to the screening and management of this under-recognized complication of inhaled corticosteroid therapy

1. Stress steroids during periods of physiological stress
     - Adrenal crisis: Hydrocortisone injection (Solu-Cortef) 100 mg/m2 (max. 100 mg) IV/IM stat with saline volume expansion, followed by 25 mg/m2 q 6 hours (max. 25 mg q 6 hours); call endocrinologist on call
     - Surgery: Hydrocortisone injection (Solu-Cortef) 50-100 mg/m2 IV (max 100 mg) pre-operatively, then 25 mg/m2 q 6 hours (max 25 mg q 6 hours); call endocrinologist on call
     - Illness or fever: 20 mg/m2/day hydrocortisone equivalent, divided BID or TID
     - Fever >38.5oC or vomiting: 30 mg/m2/day hydrocortisone equivalent, divided TID
     - Unable to tolerate orally: Hydrocortisone must be administered parenterally as Solu-Cortef, 25 mg/m2/dose q 6 hours IV or q 8 hours IM
2. ± Daily physiologic dose of hydrocortisone (8-10 mg/m 2 /day)
3. Family education
     - Stress steroid dosing
     - Emergency medical contact information in case of illness
4. Information card/Medic-Alert bracelet
  1. IV: intravenous; IM: intramuscular; BID: twice daily; TID: three times daily; QID: four times daily; q: every