Steroid Stress Dosing and Weaning Clinical Pathway – Chronic GC Therapy with Hydrocortisone

Steroid Stress Dosing and Weaning Clinical Pathway

Chronic Glucocorticoid Therapy with Hydrocortisone

Emergency/Critical Bolus Dose for Severe Stress
  • If a calculated BSA is available, the emergent first dose should be hydrocortisone based on BSA.
  • If a calculated BSA is unavailable, the emergent first dose should be hydrocortisone based on age.
  • Stress dosing regimens to be initiated after the hydrocortisone severe stress bolus dose are provided in the Stress Dosing Regimen table below.
Severe Stress Hydrocortisone dose by BSA
IV, IM		 100 mg/m2
Max dose 100 mg
Hydrocortisone dose by age
IV, IM		 Age 0-24 mos 25 mg
Age 25 mos to 10 yrs 50 mg
Age > 10 yrs 100 mg
Moderate
Stress		 No emergent bolus dose necessary, see section below
Stress Dosing Regimens for Moderate and Severe Stress:
Chronic Glucocorticoid Therapy with Hydrocortisone
  • Hold daily home dose of hydrocortisone and replace with stress dose hydrocortisone.
  • Stress dosing regimen doses are based on the child's current maintenance dose and degree of stress.
  • Severe stress dosing will be in the inpatient setting only.
Severe Stress Hold
  • Begin 6 hrs after hydrocortisone stress dose
  • Hydrocortisone 25 mg/m2/dose IV every 6 hours
    (equivalent to 100 mg/m2/day), up to 50 mg/dose
Moderate Stress Hold
  • Start enteral or IV hydrocortisone at doses listed below
    • Enteral
      • Hydrocortisone 15 mg/m2/dose PO every 8 hours
        (approximately 50 mg/m2/day), up to 30 mg mg/dose
    • IV
      • Hydrocortisone 12.5 mg/m2/dose IV every 6 hours
        (equivalent to 50 mg/m2/day), up to 25 mg/dose.