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Question: Endocrine

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You are seeing a 5 year old child with known adrenal insufficiency with fluid and pressor-resistant hypotension. You wish to give stress-dose steroids. 

Which of the following is your best choice:


pemsou5_wp • January 17, 2023

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  1. Kelly January 20, 2023 - 9:57 pm Reply

    B) 50mg IM hydrocortisone
    Adrenal insufficiency can be exacerbated by stressful situations such as acute febrile illness, dehydration, trauma, and surgery. Suspect it in patients with fluid and pressor-resistant hypotension with a known or suspected reason for adrenal insufficiency (adrenal insufficiency disorder, recent cessation of high dose or chronically administered exogenous glucocorticoids). Hydrocortisone is the preferred glucocorticoid: 50-100 mg/m2 body surface area or 1-2 mg/kg (a 5 year old would typically weigh 20 kg) IV. However, emergent IM dosing can be administered as 25mg for infants and toddlers through age 3 years, 50mg for children, and 100mg for teens and older. Dexamethasone should not be used for primary adrenal insufficiency as it has no mineralocorticoid effect. However, secondary insufficiency due to chronic steroid administration does not cause mineralocorticoid insufficiency. Methylprednisolone can be used, but hydrocortisone is preferred.

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