Systemic corticosteroid

⚠️ PCP and ACP: requires BCEHS-specific education

Acute adrenal crisis (→ E02: Adrenal Crisis)

CCP: Severe septic shock unresponsive to fluid and vasopressor therapy

CCP: Status asthmaticus

CCP: Chronic renal insufficiency

• Hypersensitivity to hydrocortisone or other corticosteroids
• Systemic fungal infections

Intravenous:

• Onset: 1 hour
• Peak: variable
• Duration: variable

• Cardiovascular: Atheromatous embolism, bradycardia, cardiac arrhythmia, cardiac failure (especially in susceptible patients), cardiomegaly, circulatory shock, hypertension, hypertrophic cardiomyopathy (premature infants), myocardial rupture (post-myocardial infarction), syncope, tachycardia, thromboembolism, thrombophlebitis, vasculitis
• Central nervous system: Arachnoiditis (intrathecal administration), depression, emotional lability, euphoria, headache, increased intracranial pressure (with pseudotumor cerebri; usually following discontinuation), insomnia, malaise, meningitis (intrathecal administration), myasthenia, neuritis, neuropathy, paraplegia (intrathecal administration), paresthesia, personality changes, psychiatric disorder, seizure, sensory disturbance (intrathecal administration), tingling of skin (especially in the perineal area after IV injection), vertigo
• Dermatologic: Acne vulgaris, allergic dermatitis, alopecia, atrophic striae, burning sensation of skin (especially in the perineal area after IV injection), diaphoresis, ecchymosis, erythema (including facial), exfoliation of skin, hyperpigmentation, hypertrichosis, hypopigmentation, skin atrophy, skin rash, suppression of skin test reaction, urticaria, xeroderma
• Endocrine & metabolic: Adrenal suppression, Cushing syndrome, diabetes mellitus (latent), fluid retention, glycosuria, growth suppression, hirsutism, HPA-axis suppression, hypercalcemia (associated with cancers), hyperglycemia (including increased requirements for insulin or oral hypoglycemic agents in diabetes mellitus), hypokalemia, hypokalemic alkalosis, impaired glucose tolerance, lipodystrophy, lipomatosis (epidural), menstrual disease (menstrual irregularities), moon face, negative nitrogen balance, protein catabolism, sodium retention, weight gain
• Gastrointestinal: Abdominal distention, carbohydrate intolerance, dyspepsia, gastrointestinal disease (intrathecal administration), gastrointestinal perforation (small and large intestine, particularly in patients with inflammatory bowel disease), hiccups, increased appetite, nausea, pancreatitis, peptic ulcer (with possible perforation and hemorrhage), ulcerative esophagitis, vomiting
• Genitourinary: Asthenospermia, bladder dysfunction (intrathecal administration)
• Hematologic & oncologic: Leukocytosis, petechia
• Hepatic: Hepatomegaly, increased serum transaminases (usually mild elevations and reversible on discontinuation)
• Hypersensitivity: Anaphylaxis, angioedema, hypersensitivity reaction
• Infection: Increased susceptibility to infection, infection, sterile abscess
• Local: Atrophy at injection site (cutaneous and subcutaneous), postinjection flare (intra-articular use), skin edema
• Neuromuscular & skeletal: Amyotrophy, Charcot-like arthropathy, lower extremity weakness (intrathecal administration), osteonecrosis (aseptic necrosis of femoral and humoral heads), osteoporosis, pathological fracture (long bones), rupture of tendon (particularly Achilles tendon), steroid myopathy, vertebral compression fracture
• Ophthalmic: Cataract (posterior subcapsular), exophthalmos, glaucoma, increased intraocular pressure, retinopathy (central serous chorioretinopathy)
• Respiratory: Pulmonary edema
• Miscellaneous: Wound healing impairment

Source: Hydrocortisone. In: Lexicomp Online, UpToDate, Waltham, MA. (Accessed November 20, 2020.) 

• May cause hypercortisolism, particularly in younger children or when used for long periods of time at higher doses.  
• Use with caution in patients with heart failure or hypertension: corticosteroids have been associated with fluid retention and electrolyte disturbance.  
• Corticosteroids have been associated with myocardial rupture when used in acute myocardial infarction. 
• Corticosteroids should not be administered for sepsis in the absence of shock. 

• Corticosteroids may enhance the adverse or toxic effects of non-steroidal anti-inflammatory agents and salicylates (including gastrointestinal ulceration and bleeding).  They may also reduce the serum concentration of salicylates. 
• May decrease the serum concentration of phenytoin.
• May enhance the anticoagulant properties of warfarin.