Adrenal crisis hydrocortisone dosing regimen
Adult patients with suspected adrenal crisis should receive immediate parenteral hydrocortisone 100 mg (IV or IM). [1] After the initial dose, hydrocortisone 200 mg per 24 hours should be administered (preferably by continuous IV infusion, or as divided IV/IM injections of 50 mg every 6 hours) until clinical recovery and specialist guidance. [1][2]
Medication administration sequence
- Immediate dose: hydrocortisone 100 mg IV or IM. [1][2]
- Maintenance for first 24 hours: hydrocortisone 200 mg/24 hours. [1][2]
- Route options for maintenance:
- Continuous IV infusion hydrocortisone 200 mg over 24 hours. [1][2]
- Alternative bolus regimen: hydrocortisone 50 mg IV or IM every 6 hours (total 200 mg/24 hours). [1][2]
Treatment initiation thresholds
Hydrocortisone should be administered as soon as adrenal crisis is suspected rather than waiting for diagnostic confirmation. [2]
Duration of high-dose glucocorticoid therapy
High-dose hydrocortisone should be continued until clinical recovery and further guidance from an endocrinologist or specialist team. [1][2]
Common pitfalls to avoid
- Delayed administration of parenteral hydrocortisone after suspicion of adrenal crisis should be avoided. [2]
- Inadequate total daily glucocorticoid dosing should be avoided. [1]
Safety note on dosing
The recommended adrenal crisis regimen specifies a total hydrocortisone dose of 200 mg over 24 hours after the initial 100 mg parenteral bolus. [1][2]