Medical or surgical stress | Examples of stress | Recommended GC dose in addition to usual GC dose | |
---|---|---|---|
Minor | Procedure/surgery: | • Inguinal hernia repair | Hydrocortisone 25 mg or equivalent pre-op |
 | Medical illness: | • Mild febrile illness | Hydrocortisone 25 mg/day or equivalent* |
• Mild-moderate nausea/vomiting | |||
• Gastroenteritis | |||
Moderate | Surgery: | • Open cholecystectomy | Hydrocortisone 50–75 mg/day or equivalent from pre-op until 1–2 days after procedure* |
• Segmental colon resection | |||
• Total joint replacement | |||
• Abdominal hysterectomy | |||
 | Medical illness: | • Significant febrile illness | Hydrocortisone 50–75 mg/day or equivalent during illness* |
• Severe gastroenteritis | |||
Severe | Surgery: | • Pancreatoduodenectomy | Hydrocortisone 100–150 mg/day or equivalent from pre-op until 2–3 days after procedure* |
• Esophagogastrectomy | |||
• Liver resection | |||
• Surgery involving cardiopulmonary bypass | |||
 | Medical illness: | • Pancreatitis | Hydrocortisone 100–150 mg/day or equivalent during illness* |
Critical illness |  | Hydrocortisone 50–100 mg IV q 6–8 hours then taper as clinical status improves |