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Peri-Operative Dosing (for patient on Steroids)

- pts who have had adrenalectomy, adrenal insufficiency, pituitary surgery, renal cell ca, or seminoma therapy should be given supplemental steroids; 
- previously, it has been recommended that patients who are on steroids or who have taken steroids in the past year be provided with supplemental IV steroids inorder to prevent an adrenal crisis; 
- an adrenal crisis can be manifestated by hypotension, hyponatremia, and ileus; 
- these recommendations are now controversial in light of the study by Friedman et al (1995) who noted that none of 28 steroid patients developed an adrenal crisis following surgery eventhough they did not receive supplemental IV steroids; 

- dosage:
- hydrocortisone 100 mg IVPB on call to the OR; 
- hydrocortisone 100 mg IVPB in the recovery room & q6hr x 24hr; 
- then, may reduce to 50 mg q6hr x 24hr, then taper over 3-5 days; 
- incr dosage to 200-400 mg / 24hr w/ hypoNa, fever, or hypotension; 
- if patient is Potassium wasting then may switch to Solumedrol

- physiological replacement:
- hydrocortisone (cortisol) (t/2 = 60min) 
- IM: 2.5 mg/M2/day, qd to every 3days; 
- PO: 25 mg/M2/day divided tid - cortisone acetate 
- IM: 16 mg/M2/day, qd to every 3 days; 
- PO: 32 mg/M2/day, divided tid 

- prednisone
- PO: 4-5 mg/M2/day, divided bid 
- dose must be individually adjusted to provided adequate replacement w/o excessive side effects 

Use of Supplemental Steroids in Patients Having Orthopaedic Operations.

- Discussion: