Pathway for the Child at Risk for HPA Suppression:
Stress Steroid Dosing and Weaning Recommendations

Child at Risk for HPA Suppression

Meets Definition of Chronic
Glucocorticoid Therapy

Emergent/Critical Dosing Required
  • Based on Patient Condition
  • Length not immediately available

Use Hydrocortisone IV, IM

Severe
  • < 2 yrs 50 mg IV/IM
    ≥ 2 yrs 100 mg IV/IM
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Determine if Severe or Moderate Stress
Based on procedure, severity of illness
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Stress dose is based on patient's current maintenance dose
Give daily dose of dexamethasone
and ADD stress dose hydrocortisone
Hold daily dose and give
stress dose
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Patient / Family Education
Case Examples:
Determining Stress Level Weaning Glucocorticoids
Posted: September 2014
Revised: May 2016
Authors: A. Palladino, MD; S. Burnham, MD; C. Jacobstein, MD; V. Srinivasan, MD; H. Zhang, MD; L. Bevington, RN; R. Grundmeier, MD; J. Chuo, MD; L. Utidjian, MD; K. Lord, MD; R. Hughes, PharmD;