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Steroid Stress Dosing and Weaning Clinical Pathway – Definition

Steroid Stress Dosing and Weaning Clinical Pathway

Meets Definition of Chronic Glucocorticoid Therapy

Definition: Adrenal insufficiency is common following 2 wks of glucocorticoid therapy, thus placing the child at risk for adrenal crisis during acute illness or other stresses, such as surgery or other minor procedures.

Child Meeting Any of the Following Criteria Requires a Stress Dosing Plan
  • Daily glucocorticoid therapy for ≥ 2 wks of:
    • Hydrocortisone: > 10 mg/m2/day
    • Prednisone/prednisolone/methylprednisolone: any dose
    • Dexamethasone: any dose
    • Vamorolone or deflazacort: any dose, consult Endocrinology for management
  • History of chronic or repeated oral/IV steroid exposure within the past 12 months without recent adrenal axis evaluation, or those with evidence of Cushingoid features on physical examination
    • e.g., 3-5 day pulse courses of oral/IV steroids more than 6 times per year

Exclusions

Topical steroid treatment only
Oncology patients on CAR T-cell Therapy: consult Oncology

 

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