Peri- and post-operatively, use pre-filled drugs chart (Printable Chart). Only proceed to oral hydrocortisone if is tolerating oral intake. If not, patient will need to stay on im (or possibly an iv infusion) of hydrocortisone until eating and drinking properly.
Surgical protocol:
| Operative day | 50mg hydrocortisone qds im |
| Post-op day 1 | 50mg hydrocortisone tds im |
| Post-op day 2 | Oral hydrocortisone 20mg 9am, 10mg 12 midday, and 10mg 4pm |
| Post-op day 3 | Oral hydrocortisone 10mg 9am, 5mg 12 midday. |
| Post-op day 4 | Switch via coding to endocrine team rather than neurosurgical team (Mendoza to Meeran, neurosurgical team to trigger) |
Post-op day 4 take 09.00 am serum cortisol sample (done by Endocrine F1/F2) into a RED topped tube. Call CXH duty Clinical Biochemist on bleep 8256 (telephone 30348) to warn of sample coming. Mark as URGENT and deliver to lab on First Floor. Hand over sample to staff (do not leave in basket outside) and tell them ‘urgent for cortisol as discussed with Duty Clinical Biochemist’.