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Patients Undergoing a Surgical OR Endoscopy Procedure With a Presumed Risk for Adrenal Crisis

Situations in which operative steroid stress-dosing is necessary:

  • Patient is taking steroids and exhibits Cushnoid features.

Situations in which stress-dose steroids maybe necessary:

  • Daily inhaled corticosteroids (ICS) at a dose of fluticasone > 750 mcg/day (or equivalent ICS) for > 3 months.
  • Daily topical Class I-III steroids for > 3 weeks (such as: Clobetasol, Lidex, Elocon ointment, Betamethasone, Topicort ointment).
  • Daily enteral/parenteral prednisone 5 mg (or equivalent steroid dose) for >3 weeks.
  • Daily enteral/parenteral steroids, regardless of dose, at bedtime for > 3 weeks.
  • Less than 1 year after completing prolonged course of above steroids (>3 months).

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Disclaimer

This care process model does not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare care process models for each. Accordingly, this care process model should guide care with the understanding that departures from them may be required at times.