Pathway for the Child at Risk for HPA Suppression:
Stress Steroid Dosing and Weaning Recommendations
Child at Risk for HPA Suppression
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
Determine if Severe or Moderate Stress
Based on procedure, severity of illness
Based on procedure, severity of illness
Stress dose is based on patient's current maintenance dose
Give daily dose of dexamethasone
and ADD stress dose hydrocortisone
and ADD stress dose hydrocortisone
Hold daily dose and give
stress dose
stress dose
Patient / Family Education
Case Examples:
Determining Stress Level Weaning Glucocorticoids
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;
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;
References
- Adrenal Axis Function After High-Dose Steroid Therapy for Childhood Acute Lymphoblastic Leukemia
- Adrenal Insufficiency: Still a Cause of Morbidity and Death in Childhood
- Are Guidelines for Glucocorticoid Coverage in Adrenal Insufficiency Currently Followed?
- A Search for Variables Predicting Cortisol Response to Low-Dose Corticotropin Stimulation Following Supraphysiological Doses of Glucocorticoids