Updated 7/21/2020

FOR EMERGENCY AND HOSPITAL PERSONNEL

covid-19 - aDRENAL INSUFFICIENCY AND STEROID DOSING GUIDELINES
for adults

This information sheet is for adults who have suspected or confirmed COVID-19 with acute symptoms.

​POINT OF INITIAL CONTACT WITH EMERGENCY PERSONNEL

In Ambulance en route to Emergency Room

Administer 100 mg of hydrocortisone IM or IV. 

In Emergency Room

Start IV isotonic saline solution, draw blood for labs and then immediately administer 100 mg of hydrocortisone IV .

HOSPITAL CARE

Hydrocortisone and fluid - on or off of a ventilator or supplemental oxygen

FIRST 24 HOURS: Give hydrocortisone (100 mg IV bolus), followed by 50 mg IV every 6 hours (or 200 mg/24 hours as a continuous IV infusion for the first 24 hours). If hydrocortisone is unavailable, alternatives include prednisolone, prednisone, and dexamethasone. Infuse 2-3 liters of isotonic saline or 5% dextrose in isotonic saline as quickly as possible. Frequent hemodynamic monitoring and measurement of serum electrolytes should be performed to avoid iatrogenic fluid overload. Discontinue fludrocortisone in adults.

AFTER FIRST 24 HOURS: Continue intravenous isotonic saline at a slower rate for the next 24-48 hours. Taper parenteral glucocorticoid over 1-3 days to oral glucocorticoid maintenance dose. 

VENTILATOR AND SUPPLEMENTAL OXYGEN CARE

See above for glucocorticoid and fluid recommendations. Dexamethasone: The COVID-19 Treatment Guidelines Panel (the Panel) recommends using dexamethasone (at a dose of 6 mg per day for up to 10 days) in patients with COVID-19 who are mechanically ventilated and in patients with COVID-19 who require supplemental oxygen but who are not mechanically ventilated.

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As recommended for all affected by COVID-19, patients should rest and counteract the fever by taking 1000 mg doses of acetaminophen every 6 hours in adults They should try to rest and keep well hydrated by drinking regularly.

RECOVERY

Continue intravenous isotonic saline at a slower rate for the next 24-48 hours. Taper parenteral glucocorticoid over 1-3 days or if complicating illness permits, to oral glucocorticoid maintenance dose.

​Restart fludrocortisone dose by mouth when saline infusion is stopped.

Sources:

​adrenal_crisis_alert_flyer.pdf

https://eje.bioscientifica.com/view/journals/eje/183/1/EJE-20-0361.xml

https://www.covid19treatmentguidelines.nih.gov/dexamethasone/ 

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