Hydrocortisone (ICU — Stress Dosing)

How it works

It activates glucocorticoid receptors to suppress inflammation and, via mineralocorticoid activity, supports sodium and water balance; it replaces cortisol in adrenal insufficiency.

Prescribing in practice

• In known or suspected adrenal insufficiency, do not omit doses and increase ('stress dose') during illness, surgery or trauma to avoid an adrenal crisis.
• Patients on long-term steroids need a steroid card and must not stop abruptly.
• The usual glucocorticoid adverse effects apply with prolonged use (hyperglycaemia, infection risk, etc.).

Monitoring

Monitor blood glucose, blood pressure, fluid balance and electrolytes; in replacement therapy review for under- or over-treatment.

Counselling the patient

• If you are steroid-dependent, never miss doses and increase the dose when unwell — carry a steroid card.
• Seek urgent help if you cannot keep doses down when ill (risk of adrenal crisis).

Evidence & guidelines

Standard for adrenal-insufficiency replacement and stress dosing, and used in acute allergic/inflammatory emergencies.