Clinical Pathway for the Child at Risk for Adrenal Suppression:
Stress Steroid Dosing and Weaning Recommendations

Child at Risk for Adrenal Suppression
Meets Definition of
Chronic Glucocorticoid Therapy

 

  • Emergent/Critical Dosing Required
  • Based on Patient Condition
  • Steroid duration not immediately available
  • Use Hydrocortisone IV, IM
  • Severe Stress Only
  • Age 0-24 mos: 25 mg
    Age 25 mos to 10 yrs: 50 mg
 
 
Determine if Severe or Moderate Stress
Based on procedure, severity of illness
 
 
 
 
 
 
 
 
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
 
 
 
 
 
 
 
 
 
 
Case Examples:
Determining Stress Level Weaning Glucocorticoids