I had a patient with known Addison’s who had been on steroids for almost 40 years since his Addison’s disease was diagnosed. He came in with pyelonephritis and the admitting physician didn’t start the stress dose steroids. When we saw the patient the next day and the patient was lethargic and couldn’t keep his eyes open (but was AOx3 when he would). He was also hypotensive, hyperkalemic, but was normonatremic. He was very sick looking. We started Hydrocortisone 100 mg IV q8h as well as Ceftriaxone for the pyelonephritis. The next morning on rounds, he looked like a totally new person. He was asking to eat a burger.
Day #1, he got Hydrocortisone 100 mg IV q8h. (Total of 300 mg in 24 hours).
Day #2, he got Hydrocortisone 100 mg IV q12h. (Total of 200 mg the next 24 hours).
Day # 3, he got Hydrocortisone 50 mg IV q12h. Total of 100 mg that day.
Day #4, he returned to his maintenance dose.
