What is the recommended stress dose of hydrocortisone during labor for patients on chronic glucocorticoid therapy?

The recommended stress dose of hydrocortisone for patients on chronic glucocorticoid therapy during labor is typically understood to be 100 mg every 8 hours. This recommendation is based on the need to provide adequate glucocorticoid coverage during the stress of labor, as these patients may be at risk for adrenal insufficiency due to their corticosteroid use.

Chronic glucocorticoid therapy can suppress the hypothalamic-pituitary-adrenal (HPA) axis, leading to inadequate endogenous cortisol production, particularly during times of physiological stress, such as labor. A stress dose helps to mimic the body's natural response to stress and maintain hemodynamic stability and physiological function.

The dosing of 100 mg every 8 hours has been widely adopted and ensures that adequate cortisol levels are maintained without excessive dosing that might lead to unnecessary side effects, hence promoting better outcomes during the labor process. This regimen strikes a balance, providing sufficient glucocorticoids while minimizing potential risks associated with higher doses.

Dosing options that are significantly higher or more frequent are generally not recommended in this scenario as they could lead to complications or adverse effects, such as immunosuppression or metabolic disturbances.