Steroid Stress Dosing and Weaning Clinical Pathway — Emergency, ICU, Inpatient, and Outpatient Specialty Care

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Patient/Family Education

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

Determine if Severe or Moderate Stress
Based on procedure, severity of illness

Stress Dosing Recommendations
Based on Glucocorticoid Formulation

Chronic GC Therapy with
PREDNISONE

Chronic GC Therapy with
DEXAMETHASONE

Chronic GC Therapy with
HYDROCORTISONE

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

Duration of Stress Dosing

Weaning Indications / Dosing Always Required
for Patients On Stress Dosing > 14 Days

Stress Dose Precautions Dosing, Duration, HPA Evaluation

Patient / Family Education

Case Examples:
Determining Stress Level Weaning Glucocorticoids

Steroid Potency,
Physiologic Dosing,
Symptoms of Adrenal Insufficiency

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;

References

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.