From: Perioperative care of congenital adrenal hyperplasia – a disparity of physician practices in Canada
Condition | Suggested Action |
---|---|
Home management of illness with fever. Unable to tolerate oral medications due to gastroenteritis or trauma | Hydrocortisone replacement doses doubled (> 38 °C) or tripled (> 39 °C) until recovery (usually 2 to 3 days); increased consumption of electrolyte containing fluids as tolerated |
IM/SC Hydrocortisone 50 mg/m2 or estimate; infants 25 mg, school-aged children 50 mg, adolescents 100 mg. | |
Minor to moderate surgical stress | Intramuscular/Intravenous Hydrocortisone 50 mg/m2 or hydrocortisone replacement doses doubled or tripled |
Major Surgical Stress with general anesthesia, trauma, or diseases that require intensive care | Hydrocortisone 50 mg/m2 intravenous followed by hydrocortisone 50–100 mg/m2/d divided q6 h |
Weight-appropriate continuous intravenous fluids (dextrose containing) | |
Rapid tapering and switch to oral regimen depending on clinical state | |
Acute adrenal crisis | Rapid bolus of normal saline (0.9%) 20 mL/kg. Can repeat up to a total of 60 mL/kg within 1 h for shock. |
Hydrocortisone 50–100 mg/m2 bolus followed by hydrocortisone 50–100 mg/m2/d divided q 6 h | |
For hypoglycemia: dextrose 0.5–1 g/kg of dextrose or 2–4 mL/kg of D25W (maximum single dose 25 g) infused slowly at rate of 2 to 3 mL/min. Alternatively, 5–10 mL/kg of D10W for children < 12 y old | |
Cardiac monitoring: Rapid tapering and switch to oral regimen depending on clinical state |