Correspondence  |   March 2018
One Size Fits All for Stress-dose Steroids
Author Notes
  • Mount Sinai School of Medicine, New York, New York. david.wax@mssm.edu
  • (Accepted for publication November 27, 2017.)
    (Accepted for publication November 27, 2017.)×
Article Information
Correspondence
Correspondence   |   March 2018
One Size Fits All for Stress-dose Steroids
Anesthesiology 3 2018, Vol.128, 680-681. doi:10.1097/ALN.0000000000002052
Anesthesiology 3 2018, Vol.128, 680-681. doi:10.1097/ALN.0000000000002052
Liu et al. provide a thorough review of perioperative steroid replacement and make evidence-based recommendations to help clear up the “confusing” recommendations about who needs “stress-dose” steroids, what agent to administer, and how much to administer.1  They report that there is limited evidence that such supplementation is necessary, but continue on to provide an algorithm for how much hydrocortisone to give at-risk patients based on anticipated surgical stress. They also point out that mineralocorticoid deficiency does not occur in secondary adrenal insufficiency (i.e., due to chronic exogenous steroid administration). They also indicate that administration of hydrocortisone can result in excess mineralocorticoid activity with resulting (and undesirable) fluid retention and hypokalemia.
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