Hydrocortisone

Hydrocortisone

Indication

• Severe inflammation, acute adrenal insufficiency, shock, hypoglycemia, simple allergic blood transfusion reactions, congenital adrenal hyperplasia

Pharmacology

• A steroid which possesses glucocorticoid activity with some mineralocorticoid effects
• Most effects likely result from modification of enzyme activity, thus affecting virtually all body systems
• Promotes protein catabolism, gluconeogenesis, renal excretion of calcium and red cell production; suppresses immune and inflammatory responses
• The relative anti-inflammatory potency of hydrocortisone is 1/4 that of prednisone and about 1/30 that of dexamethasone
• The relative mineralocorticoid activity of hydrocortisone is slightly greater (~20%) than that of prednisone; dexamethasone is virtually devoid of mineralocorticoid activity

Precautions

• gradually reduce drug dosage after continued use: Do not stop abruptly
• Monitor infant's weight, blood pressure, serum electrolytes, serum and urinary glucose
• may mask or exacerbate infections
• do not confuse Solu-Cortef(R) with Solu-Medrol(R)
• The potential for short and long term adverse neurological effects resulting from steroid use needs to be considered when using hydrocortisone

Dose

1. Hypotension
   1. 1 mg/kg IV q6h
   2. Most reports in the literature recommend initial therapy with volume expanders, then inotropes, before starting hydrocortisone
2. Hypoglycemia
   1. 1 to 2 mg/kg IV q8h
3. Acute Adrenal Insufficiency
   1. 1 to 2 mg/kg IV q6h
4. Congenital Adrenal Hyperplasia
   1. initial: 1 to 1.2 mg/kg/24h (divided 1/4 in am, 1/4 at noon, 1/2 at night (IV or po)
   2. maintenance: 0.7 to 0.8 mg/kg/24h (divided as above)

• In emergency situations give slow IV push; in other instances give by slow infusion

Side Effects

• CVS: hypertension, fluid retention
• GI: gastritis, GI hemorrhage
• metabolic: hyperglycemia, hypernatremia, hypocalcemia, hypokalemia
• skin: slow wound healing
• increased predisposition to infection

Supplied As

• 5 mg/ml patient specific syringes, prepared by Pharmacy
• 50 mg/ml (when reconstituted, but dilute to 5 mg/ml before administering), 2 ml vial