Stress‑Dose Steroids in Septic Shock With Chronic Glucocorticoid Use
Stress‑dose glucocorticoids are indicated in patients with septic shock who are receiving chronic glucocorticoid therapy and develop refractory hypotension despite adequate fluid resuscitation and vasopressor support. The recommendation is to administer hydrocortisone as the stress‑dose agent. [1][2]
Recommended Agent and Dose
- Hydrocortisone 50 mg intravenously every 6 hours (total 200 mg /day). [1][2]
Route of Administration
- Intravenous bolus or continuous infusion; both routes achieve equivalent plasma concentrations. [1]
Typical Duration
- Continue hydrocortisone for 5–7 days or until vasopressors are no longer required, then taper over 2–3 days to avoid adrenal insufficiency. [1][2]
Practical Considerations
- Monitor blood pressure, serum glucose, and electrolytes during therapy. [1]
- Avoid high‑dose short‑course regimens (> 400 mg hydrocortisone‑equivalent per day for < 3 days) as they are not recommended. [3]
- Tapering is advised once vasopressor support is discontinued to reduce the risk of rebound shock. [4]