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Table 16 Recommendations for the management of AS in adults

From: A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy

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

  1. *If a corticosteroid with a short half-life (e.g., hydrocortisone) is given, then GC dose should be divided into 2–3 doses/day.
  2. Adapted from: Coursin, Wood, 2002 [161] and Salem et al., 1994 [162].