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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].