Stress Dose Causing Distress

267 Sir, The risks of failure to provide stress dose of steroids have been well documented so that every endocrinologist spends adequate time to educate the patient regarding the importance of stress dose of steroids. There is a lack of clarity in the literature regarding the type of steroid in stress replacement. The traditional advice is to double or triple the dose of steroid. This is based on the assumption that during medical stress, since the adrenal is unable to augment cortisol production, the patient needs an increase in the dose of exogenous insulin. The normal cortisol production is only about 10 mg/day.[1] Since hydrocortisone is equivalent to cortisol, this would be around 10 mg of hydrocortisone per day.