Adrenal Crisis
Risks
Adrenal suppression likely (as per UTD)
- total daily equivalent of 20mg prednisolone in adult for >3w OR
- nocte equivalent of 5mg prednisolone in adult for >3w
- anyone who has become cushingoid
- equivalent of <20mg prednisolone in adult for >3w (but not >5mg at night)
- any dose <3w
Tapering dictated by
- possibility of adrenal insufficiency
- possibility of relapse of disease with rapid with drawal
Ix EUC/Glucose/ACTH/Cortisol
Stress cover ie aiming to prevent adrenal crisis
Oral hydrocortisone equivalent is given as quicker absorption
- Minor stress: mild infection (sore throat, rhinorrhoea, temp < 38ºC) normal dose
- Moderate stress: severe upper respiratory infections - 2 x total daily dose
- Major stress: Temp > 38ºC / vomiting (will need IM/IV) 4 x total daily dose
- 0 to 3 years old: Hydrocortisone 25 mg IM/IV
- 3 to 12 years old: Hydrocortisone 50 mg IM/IV
- 12 years and older: Hydrocortisone 100 mg IM/IV
- above dose stat (at induction / recognition of crisis)
- same dose as infusion over next 24 hours
- 25mg/m2 at induction
- 50mg/m2 infusion spread over the duration of the operation
- 50mg/m2 infusion over the following 24 hours postop
- total daily dose q6h IV/PO for next 24 hours (ie 4 x TDD for the 24hr)
- wean clinically