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ata-major-stress-hc-regimen

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Actualizado27 de junio de 2026 a las 01:34

Administers 100-mg hydrocortisone IV bolus followed by continuous IV infusion of 200 mg HC per 24 hours (alternatively 50 mg IV every 6 hours) for patients undergoing major surgical stress. Use when managing patient with major surgical stress; triggers include patient undergoing major surgery.

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dromlakhani

dromlakhani/MD2SKILL

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SKILL.md

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name	ata-major-stress-hc-regimen
description	Administers 100-mg hydrocortisone IV bolus followed by continuous IV infusion of 200 mg HC per 24 hours (alternatively 50 mg IV every 6 hours) for patients undergoing major surgical stress. Use when managing patient with major surgical stress; triggers include patient undergoing major surgery.

Administer 100-mg hydrocortisone IV bolus followed by continuous infusion for major surgical stress

STEP 1 — Gather Information

Confirm diagnosis of central adrenal insufficiency (AI) or high suspicion, verify patient is undergoing major surgical stress, review current glucocorticoid regimen, assess for signs of adrenal crisis, and check fluid status and glucose; if AI confirmed/suspected and major surgical stress present, proceed to Step 2.

STEP 2 — Rule In / Rule Out

Is the patient diagnosed with central AI or has high suspicion of AI? If yes, proceed to Step 3; if no, consider standard perioperative glucocorticoid dosing or hold stress dose and reassess.

STEP 3 — Classify or Stratify

Classify stress level as major surgical stress (e.g., bowel resection, cardiac surgery, major orthopedic procedure) versus minor/moderate stress; if major, continue to dosing decision.

STEP 4 — Decide

Administer 100 mg hydrocortisone IV bolus, then start continuous IV infusion of 200 mg HC per 24 hours (or 50 mg IV every 6 hours) and monitor response.

Clinical Guardrails / Mimics / Pitfalls

Avoid excessive dosing that may cause hyperglycemia, fluid overload, or infection; do not use dexamethasone in pregnancy; taper glucocorticoids postoperatively once HPA axis recovers; monitor for signs of adrenal insufficiency despite stress dosing; consider renal function when adjusting infusion rate; ensure patient has emergency glucocorticoid kit.

Concrete Clinical Example

A 48-year-old man with known central AI undergoing open abdominal aortic aneurysm repair receives 100 mg HC IV bolus in the operating room, followed by a continuous infusion of 200 mg HC over 24 hours (≈8.3 mg/h); postoperative course uncomplicated.

Source: Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, https://doi.org/10.1210/jc.2016-2118

TODO: consider adding scripts/calc.py for the ata-major-stress-hc-regimen calculator

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name	ata-major-stress-hc-regimen
description	Administers 100-mg hydrocortisone IV bolus followed by continuous IV infusion of 200 mg HC per 24 hours (alternatively 50 mg IV every 6 hours) for patients undergoing major surgical stress. Use when managing patient with major surgical stress; triggers include patient undergoing major surgery.

Administer 100-mg hydrocortisone IV bolus followed by continuous infusion for major surgical stress

STEP 1 — Gather Information

STEP 2 — Rule In / Rule Out

Is the patient diagnosed with central AI or has high suspicion of AI? If yes, proceed to Step 3; if no, consider standard perioperative glucocorticoid dosing or hold stress dose and reassess.

STEP 3 — Classify or Stratify

Classify stress level as major surgical stress (e.g., bowel resection, cardiac surgery, major orthopedic procedure) versus minor/moderate stress; if major, continue to dosing decision.

STEP 4 — Decide

Administer 100 mg hydrocortisone IV bolus, then start continuous IV infusion of 200 mg HC per 24 hours (or 50 mg IV every 6 hours) and monitor response.

Clinical Guardrails / Mimics / Pitfalls

Concrete Clinical Example

Source: Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, https://doi.org/10.1210/jc.2016-2118

TODO: consider adding scripts/calc.py for the ata-major-stress-hc-regimen calculator