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

Steroid Stress Dosing and Weaning Clinical Pathway

Chronic Glucocorticoid Therapy with Dexamethasone

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-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 Dexamethasone
  • Continue home dexamethasone dose and add stress dose hydrocortisone if necessary.
  • 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.
  Current
Maintenance Dose		 Home Dose Stress Dosing Regimen
Severe Stress < 3.75 mg/m2/day
for BSA < 1 m2
or
< 3.75 mg/day
for BSA ≥ 1 m2		 Continue
  • Begin regimen 6 hrs after hydrocortisone stress dose in conjunction with dexamethasone
    • Add Hydrocortisone 25 mg/m2/dose IV every 6 hours (equivalent to 100 mg/m2/day), up to 50 mg/dose
≥ 3.75 mg/m2/day
for BSA < 1 m2
or
≥ 3.75 mg/day
for BSA ≥ 1 m2		 Continue Restart baseline dexamethasone regimen 6 hrs after hydrocortisone stress dose
Moderate Stress < 1.875 mg/m2/day
for BSA < 1 m2
or
< 1.875 mg/day
for BSA ≥ 1 m2		 Continue
  • Start enteral or IV hydrocortisone in conjunction with dexamethasone
    • Enteral
      • Hydrocortisone 15 mg/m2/dose PO every 8 hours (approximately 50 mg/m2/day), up to 30 mg/dose
    • IV
      • Hydrocortisone 12.5 mg/m2/dose IV every 6 hours (equivalent to 50 mg/m2/day), up to 25 mg/dose
≥ 1.875 mg/m2/day
for BSA < 1 m2
or
≥ 1.875 mg/day
for BSA ≥ 1 m2		 Continue Continue baseline dexamethasone at current dose