The cortisol response to stress is highly variable and dependent on a number of factors, including age, underlying health, and genetics. in general, most experts recommend doubling or tripling the daily replacement dose during mild to moderate illness until recovery (often referred to as the “sick-day rules”). • kelly k, domajnko b. perioperative stress dose steroids. clinics in colon and rectal surgery. 2013;26:163-7 • garcia j, hill g, joshi g. perioperative stress dose steroids: is it really necessary? asa newsletter. 2013;77(11):32-5 • hsu a et al. characterization of the cortisol stress response to sedation and anesthesia in children. See more videos for how to stress dose steroids. Stressdosesteroids are used in numerous scenarios including adrenal insufficiency, critical care, and the perioperative period. what’s important to understand is that the peak physiologic production of steroid (cortisol) is roughly the equivalent of 300 mg of hydrocortisone a day under maximum stress...