Steroid Conversion Calculator

Consider: (1) Duration needed - long-acting dexamethasone for single doses, intermediate for daily therapy. (2) Mineralocorticoid effects - avoid hydrocortisone if fluid retention is a concern. (3) Liver function - use prednisolone instead of prednisone in liver disease. (4) Specific protocols - betamethasone for fetal lung maturity, methylprednisolone for pulse IV therapy.

Tapering prevents adrenal insufficiency after HPA suppression. General approach: (1) For <3 weeks of therapy, often can stop without taper if low-moderate dose. (2) For longer therapy, taper by 10-20% every 1-2 weeks. (3) Slow down when reaching physiologic doses (~5-7.5 mg prednisone). (4) Monitor for fatigue, hypotension, nausea indicating adrenal insufficiency.

Mineralocorticoid activity causes sodium retention, potassium excretion, and water retention via kidney effects. This leads to edema, hypertension, and hypokalemia. Hydrocortisone and cortisone have high mineralocorticoid activity; dexamethasone has none. Choose low-mineralocorticoid steroids in heart failure, hypertension, or when fluid retention is problematic.

Patients with suppressed adrenal function need extra steroids during physiologic stress (illness, surgery). Minor stress: double or triple the usual dose. Moderate stress (e.g., minor surgery): hydrocortisone 50mg IV before procedure, then 25mg every 8h for 24h. Major stress (e.g., major surgery): hydrocortisone 100mg IV, then 50mg every 8h, taper over 1-3 days.

Prednisone is a prodrug that requires hepatic conversion to its active form, prednisolone. In patients with severe liver disease, this conversion may be impaired. Prednisolone is preferred in these patients as it's already active. For most patients with normal liver function, prednisone and prednisolone are clinically equivalent.