Updated 7/21/2020
FOR EMERGENCY AND HOSPITAL PERSONNEL
covid-19 - aDRENAL INSUFFICIENCY AND STEROID DOSING GUIDELINES
for CHILDREN
This information sheet is for children who have suspected or confirmed COVID-19 with acute symptoms.
POINT OF INITIAL CONTACT WITH EMERGENCY PERSONNEL
In Ambulance en route to Emergency Room
Administer hydrocortisone 25 mg IM or IV for infants and toddlers, 50 mg for school-aged children, 100 mg for adolescents and young adults.
In Emergency Room
Start IV isotonic saline solution, draw blood for labs and then immediately administer hydrocortisone 25 mg IV for infants and toddlers, 50 mg for school-aged children, 100 mg for adolescents and young adults.
HOSPITAL CARE
Hydrocortisone and fluid - on or off of a ventilator or supplemental oxygen
FIRST 24 HOURS:
Adolescents/Young Adults:
Give hydrocortisone (100 mg IV bolus), followed by 50 mg IV every 6 hours (or 200 mg/24 hours as a continuous IV infusion for the first 24 hours). If hydrocortisone is unavailable, alternatives include prednisolone, prednisone, and dexamethasone. Infuse 2-3 liters of isotonic saline or 5% dextrose in isotonic saline as quickly as possible. Frequent hemodynamic monitoring and measurement of serum electrolytes should be performed to avoid iatrogenic fluid overload.
Infants/Children:
Give hydrocortisone 50 mg hydrocortisone/m2 (25 mg in infants and 50 mg in children) followed by 50 mg/24 hours in infants and 100 mg/24 hours in children.
AFTER FIRST 24 HOURS FOR ALL PEDIATRIC PATIENTS:
Continue intravenous isotonic saline at a slower rate for the next 24-48 hours. Taper parenteral glucocorticoid over 1-3 days to oral glucocorticoid maintenance dose.
VENTILATOR AND SUPPLEMENTAL OXYGEN CARE
The child should be continued on hydrocortisone 3x their usual maintenance dose and up to 100 mg/ m2 /day as continued therapy for 24-48 hours as needed.
Dexamethasone: Very few pediatric patients with COVID-19 were included in the RECOVERY trial; therefore, the safety and efficacy of using dexamethasone in these patients are unknown.
Adolescents/Young Adults:
Give hydrocortisone (100 mg IV bolus), followed by 50 mg IV every 6 hours (or 200 mg/24 hours as a continuous IV infusion for the first 24 hours). If hydrocortisone is unavailable, alternatives include prednisolone, prednisone, and dexamethasone. Infuse 2-3 liters of isotonic saline or 5% dextrose in isotonic saline as quickly as possible. Frequent hemodynamic monitoring and measurement of serum electrolytes should be performed to avoid iatrogenic fluid overload.
Infants/Children:
Give hydrocortisone 50 mg hydrocortisone/m2 (25 mg in infants and 50 mg in children) followed by 50 mg/24 hours in infants and 100 mg/24 hours in children.
AFTER FIRST 24 HOURS FOR ALL PEDIATRIC PATIENTS:
Continue intravenous isotonic saline at a slower rate for the next 24-48 hours. Taper parenteral glucocorticoid over 1-3 days to oral glucocorticoid maintenance dose.
VENTILATOR AND SUPPLEMENTAL OXYGEN CARE
The child should be continued on hydrocortisone 3x their usual maintenance dose and up to 100 mg/ m2 /day as continued therapy for 24-48 hours as needed.
Dexamethasone: Very few pediatric patients with COVID-19 were included in the RECOVERY trial; therefore, the safety and efficacy of using dexamethasone in these patients are unknown.
As recommended for all affected by COVID-19, children should rest and counteract the fever by taking appropriate doses of acetaminophen every 6 hours. They should try to rest and keep well hydrated by drinking regularly.
RECOVERY
Continue intravenous isotonic saline at a slower rate for the next 24-48 hours. Taper parenteral glucocorticoid over 1-3 days or if complicating illness permits, to oral glucocorticoid maintenance dose(endocrinologist to advise).
Sources:
www.nadf.us/uploads/1/3/0/1/130191972/adrenal_crisis_alert_flyer_-_children.pdf
https://eje.bioscientifica.com/view/journals/eje/183/1/EJE-20-0361.xml
https://www.covid19treatmentguidelines.nih.gov/dexamethasone/
www.nadf.us/uploads/1/3/0/1/130191972/adrenal_crisis_alert_flyer_-_children.pdf
https://eje.bioscientifica.com/view/journals/eje/183/1/EJE-20-0361.xml
https://www.covid19treatmentguidelines.nih.gov/dexamethasone/
The National Adrenal Diseases Foundation
P.O. Box 95149, Newton, MA 02495
(847) 726-9010
www.nadf.us • [email protected]
© 2021 NADF - All Rights Reserved
P.O. Box 95149, Newton, MA 02495
(847) 726-9010
www.nadf.us • [email protected]
© 2021 NADF - All Rights Reserved