4 Uses of Hydrocortisone in EM
"Small vial, systemic impact" – Dr. Manivarma
Infographic by Dr. Manivarma • Endorsed by College of Emergency Physicians Malaysia
THYROID STORM
IV HCT 300mg STAT + 100mg TDS
The most critical function is to blocks the peripheral conversion of T4 to the highly active T3
1st LINE
De Groot LJ, et al. Thyroid Storm (Updated 2025 Apr 15). In: Feingold KR, et al. Endotext. South Dartmouth (MA): MDText.com, Inc.; 2000-.
https://www.ncbi.nlm.nih.gov/books/NBK278927/
AEBA
IV HCT 200mg/DAY
- Reduces airway inflammation and edema
- Reduced mucus secretion
Global Strategy for Asthma Management and Prevention (2025) GINA
ACUTE ADRENAL CRISIS
IV HCT 100mg STAT + 50mg QID
Provides immediate glucocorticoid and essential mineralocorticoid replacement
1st LINEKarunarathna I, Bandara S, et al. Acute Adrenal Crisis: Clinical Features, Diagnosis, and Management.
REFRACTORY SEPTIC SHOCK
IV HCT 200mg/DAY or 50mg QID
Enhances the vasoconstrictive effects of catecholamines (like norepinephrine)
2nd LINELi, Y., Wang, Y., et al. (2025). Influence of hydrocortisone infusion on septic shock: systematic review and meta-analysis. Journal of Intensive Medicine. doi:10.1016/j.jointm.2024.05.001
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