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Steroid Stress Dosing and Weaning Clinical Pathway – Determine if Severe or Moderate Stress

Steroid Stress Dosing and Weaning Clinical Pathway

Determine if Severe or Moderate Stress

Severe
  • Major surgery
  • Deep sedation*
  • Major Trauma – motor vehicle accident, head trauma
  • Sepsis
  • Repeated emesis
  • Dehydration
  • Change in mental status
Moderate
  • Anesthesia for diagnostic or minimally invasive procedures*
    • Invasive dental procedure
  • Persistent diarrhea
  • Fever
  • Emesis, 1st episode
  • Focal bacterial infection
  • Broken bone
  • Seizure
  • Concussion
  • All-day sports tournament, running a marathon
  • *Practice patterns may vary:
    • If stress dosing is deferred, the recommendation is to give a physiologic dose or patient's prescribed daily dose, whichever is higher.
    • In some cases of brief periods of anesthesia for low-risk procedures, such as a routine lumbar puncture in leukemia patients, children may not need any stress dose steroids.
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