Pedemy All toolsPick the situation. Doses use body surface area estimated from the weight entered. Tap any earlier answer to change it.
This tool gives stress-dose hydrocortisone plans for children with known adrenal insufficiency or on long-term steroids. It is for clinicians managing sick days, emergencies and surgery, and estimates body surface area from the weight entered.
You pick the situation: illness with oral medicine tolerated, vomiting or drowsiness so tablets cannot be kept down, adrenal crisis, surgery under anesthesia, or a steroid conversion table. Illness is defined as fever 38.5°C or higher, vomiting once or significant illness. Adrenal crisis includes shock, hypotension, hypoglycemia, low sodium or high potassium, or altered consciousness. Doses are based on usual maintenance of 8–10 mg/m²/day.
Sick-day rules raise oral hydrocortisone to 30–50 mg/m²/day. When oral medicine cannot be taken, the emergency IM dose is 25 mg under 3 years, 50 mg at 3–11 years and 100 mg from 12 years. In crisis, the tool gives IV hydrocortisone 50–100 mg/m² (max 100 mg), 0.9% saline 20 mL/kg and dextrose for low glucose. For surgery it gives a dose at induction. The conversion table lists prednisone, methylprednisolone and dexamethasone equivalents. Sources are the 2016 Endocrine Society guideline (Bornstein et al.), Pediatric Endocrine Society guidance and the Costeff BSA estimate.
For illness when oral medicine can be taken, the tool gives hydrocortisone 30–50 mg/m²/day divided every 6–8 hours, about double to triple maintenance, usually for 24–72 hours before returning to the usual dose.
Under 3 years: 25 mg; 3–11 years: 50 mg; 12 years and older: 100 mg (or 50–100 mg/m²). It should be given at home and EMS called when the child cannot keep tablets down.
Give IV or IM hydrocortisone 50–100 mg/m² (max 100 mg), then 50–100 mg/m²/day divided every 6 hours, plus 0.9% saline 20 mL/kg (repeat to 60 mL/kg) and dextrose 10% 5 mL/kg if hypoglycemic. Treat on suspicion without waiting for cortisol results.
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