💊 Glucocorticoid Stress Dosing & Taper
UseDecide who needs stress-dose steroids, how much to give for a given surgery, and how to taper chronic steroid…
SourceWoodcock T, et al. Guidelines for the management of glucocorticoids during the peri-operative perio…
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
Paste the link in Slack, Teams, X, or LinkedIn — the preview image comes from this page’s Open Graph card.
Methodology · worked example, guidelines & full notes
Prednisone > 20 mg/day for ≥ 3 weeks implies HPA suppression.
When to use
Decide who needs stress-dose steroids, how much to give for a given surgery, and how to taper chronic steroids.
How it works
Minor: usual dose ± hydrocortisone 25 mg. Moderate: 50–75 mg/day. Major: 100 mg + 200 mg/24h. Crisis: hydrocortisone 100 mg IV then 200 mg/24h.
Key points
- Prednisone > 20 mg/day for ≥ 3 weeks implies HPA suppression.
- Hydrocortisone is preferred for its mineralocorticoid activity.
- Adrenal crisis: hydrocortisone + isotonic fluids + treat the trigger.
- HPA recovery after a taper can take weeks to months.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| View | By surgical magnitude |
|---|
→Key pointStress dosing by surgical magnitude (hydrocortisone)
- Minor surgery/procedure：Continue the usual dose; may add hydrocortisone 25 mg IV at induction
- Moderate surgery：Hydrocortisone 50–75 mg/day (e.g. 50 mg at induction + 25 mg q8h) ×1–2 days, then taper to usual
- Major surgery：100 mg IV at induction + 200 mg/24h infusion (or 50 mg q6h) until eating, then double the oral dose for 48 h, then taper to baseline
| View | Who needs stress dosing |
|---|
→Key pointWho needs stress dosing (HPA suppression risk)
- Low risk (usually none)：Prednisone < 5 mg/day, or any dose < 3 weeks → HPA usually intact (unless crisis features)
- Uncertain：Prednisone 5–20 mg/day ≥ 3 weeks → treat as possibly suppressed or test the HPA axis
- High risk (needs stress dose)：Prednisone > 20 mg/day ≥ 3 weeks, or Cushingoid appearance → assume HPA suppression
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Glucocorticoid Stress Dosing & Taper?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Glucocorticoid Stress Dosing & Taper upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Glucocorticoid Stress Dosing & Taper calculated in practice? Can you show a worked example?
- Inputs: View By surgical magnitude → Result: Key point Stress dosing by surgical magnitude (hydrocortisone)（Minor surgery/procedure: Continue the usual dose; may add hydrocortisone 25 mg IV at induction, Moderate surgery: Hydrocortisone 50–75 mg/day (e.g. 50 mg at induction + 25 mg q8h) ×1–2 days, then taper to usual, Major surgery: 100 mg IV at induction + 200 mg/24h infusion (or 50 mg q6h) until eating, then double the oral dose for 48 h, then taper to baseline） Inputs: View Who needs stress dosing → Result: Key point Who needs stress dosing (HPA suppression risk)（Low risk (usually none): Prednisone < 5 mg/day, or any dose < 3 weeks → HPA usually intact (unless crisis features), Uncertain: Prednisone 5–20 mg/day ≥ 3 weeks → treat as possibly suppressed or test the HPA axis, High risk (needs stress dose): Prednisone > 20 mg/day ≥ 3 weeks, or Cushingoid appearance → assume HPA suppression）