Stability of Hydrocortisone Sodium Succinate in Intensive Care Units: Focus on Practical Points

Abstract

Background: Although single daily 24 hours preparation of hydrocortisone solution infusion is widely used in intensive care clinical practice, most manufacturers limit its infusion time to only four hours. The data on efficacy of this practice are scarce. Objective: To determine the physical and chemical stability of hydrocortisone solution used in intensive care units (ICU). Materials and Methods: Powder form of 100 mg hydrocortisone was reconstituted first with sterile water for injection (SWI) and then added to normal saline solution (NSS) to obtain 1 and 2 mg/mL solutions, or first reconstituted with NSS then added to bag of NSS to obtain 1 mg/mL solution. The solutions were then stored in three different conditions, refrigerator (4±2?), ICU (25±3°), and hospital room (30±2°) temperatures for 48 hours. The physical and chemical stabilities were assessed at an initial time, 4, 8, 12, 24, and 48 hours. Results: Hydrocortisone reconstituted in SWI showed an acceptable labeled amount range (100.28±3.83%), similar to reconstitution in NSS (96.05±1.00%). Hydrocortisone solutions of 1 and 2 mg/mL stored at 4±2?, 25±3°, and 30±2° showed similar percent label amount, and the statistical tests were not significantly different among the three ranges of temperatures (p>0.05). Conclusion: Hydrocortisone reconstituted using SWI followed by NSS to obtain final concentrations of 1 to 2 mg/mL or using only NSS to obtain a final concentration of 1 mg/mL, provided an acceptable range of % hydrocortisone remaining up to 48 hours when stored at 4±2?, 25±3?, and 30±2?.