Disclaimer to the Online Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.
hydrocortisone
Indication
- Corticosteroid used in the management of adrenocortical insufficiency and pressor-resistant hypotension
- Adjunctive treatment of refractory hypoglycemia
Dosage Guidelines
- Hypotension: 0.5–1 mg/kg/dose IV q6 hours
- Acute adrenal insufficiency (Adrenal Crisis): 100 mg/m2 IV x 1, then after 6 hours, 25 mg/m2/dose IV q6 hours
- New Congenital adrenal hyperplasia (CAH) with salt wasting (if in crisis, treat as above): 15 – 20 mg/m2/day divided q8 hours
- Central Adrenal Insufficiency or Primary Adrenal Insufficiency not due to CAH: maintenance 4 – 8 mg/m2/day divided q8 hours
- Hypoglycemia: 1-2 mg/kg/dose IV/oral q8 hours
Administration
- Oral: give with feeds
- IV direct over 3-5 minutes
- BSA = Body surface area (m2) = (0.05 x kg) + 0.05
- To make 10 mL of a 2 mg/mL solution:
- Reconstitution: Press down on the plastic activator of the Act-O-Vial® to force the diluent into the lower compartment (Concentration: 50 mg/mL)
- Draw up 0.4 mL of hydrocortisone injection (20 mg) into a syringe
- Add 9.6 mL sodium chloride 0.9% injection
- For example, for a 2 kg patient with acute adrenal insufficiency, the initial dose is 100 mg/m2 = 100 x [(0.05 x 2) + 0.05] = 100 x 0.15 = 15 mg = 7.5 mL of the 2 mg/mL solution. Subsequent doses would be 25 x 0.15 = 3.75 mg = 1.9 mL every 6 hours
- For a 2 kg patient with hypotension the dose would be 1 – 2 mg (0.5 – 1 mL of the 2 mg/mL solution)
Adverse Effects
- Hypertension, hyperglycemia, edema, sodium retention, hypokalemia, immunosuppression
- Growth suppression, osteoporosis with long-term use
Comments
- Taper dose after continued use. DO NOT STOP ABRUPTLY
- Maintenance dose must be tripled during concurrent illness or stress for central adrenal insufficiency or primary adrenal insufficiency
- Hydrocortisone is dosed using mg/kg for hypotension as this is the dosing that will provide pharmacological effect to increase blood pressure and mg/m2 in adrenal insufficiency as the mg/m2 dosing more closely mimics the endogenous cortisol secretion
Supplied As
- 2 mg/mL patient specific syringes, prepared by Pharmacy
- 50 mg/mL 2 mL Act-O-vial®
- 1 mg/mL oral suspension
References
LexiComp Sick Kids, LexiComp Pediatric and Neonatal, NeoFax