Thread by @AnnKumfer

11/ What if instead the pred dose is 7.5mg ? Should pt be given stress dose steroids? A JAMA review found in in patients on chronic steroids (pred doses 5-16mg) who received their usual daily dose of steroid on day of surgery, no cases of hypotension. pubmed.ncbi.nlm.nih.gov/19075176/

12/ Who should be given stress-dose steroids and how much should be given?
1. Pts w/ adrenal insufficiency on physiological dose of steroids
2. Consider if receiving major surgery (ie cardiothoracic surgery or major abdominal surgery)

Table source: pubmed.ncbi.nlm.nih.gov/11779267/

13/Caveats:
1/If a patient is unable to take oral dose of steroid prior to surgery or concern for absorption, give IV formulation
2 Giving IV hydrocort in above scenario likely be sufficient to meet physiological cortisol need but easier to keep on oral dose if tolerating PO.

Conclusions:
1. In most patients on chronic steroids receiving non-major surgery, stress dose steroids are likely unnecessary.
2. In patients w/ AI, stress dose steroids should be given. Dosage varies based on the surgery.
Additional source: pubmed.ncbi.nlm.nih.gov/27351679/

3. Increased steroid dose ⬆️risk of infection (esp pred dose >12.5mg) and ⬇️wound healing. It is beneficial to minimize steroid dose. Many times the stress dose given prior to surgery is greater than the physiologic need.