ICU Pathway for the Evaluation/Treatment of Infants > 28 Days
and Children with Severe Sepsis/Septic Shock

Stress Dose Hydrocortisone

Indications

If the patient remains hypotensive despite adequate fluid resuscitation and titration of one vasoactive infusions, consider stress-dose hydrocortisone for Critical Illness-Related Corticosteroid Insufficiency (CIRCI). If possible, send a random blood cortisol level prior to starting hydrocortisone.

Dosing Hydrocortisone

BSA 100 mg/m2 load, then 100 mg/m2/day divided q 4 hours IV
mg/kg 2 mg/kg IV load (max 100 mg), then 2 mg/kg/day
divided q 4 hours IV

Discontinuing  Hydrocortisone