Intravenous Hydrocortisone Dosing for Children in Shock
For pediatric septic shock with persistent hemodynamic instability after fluid resuscitation and vasoactive therapy, an IV hydrocortisone stress-dose regimen is commonly used as 2 mg/kg IV (hydrocortisone sodium succinate), with a maximal dose of 200 mg. [1]
Indication Context
This dosing is used in the setting of catecholamine-resistant shock. [1]
Dosing Regimen
- Hydrocortisone sodium succinate 2 mg/kg IV bolus (maximum 200 mg). [1]
Alternative Trial-Based Maintenance Regimen
In pediatric septic shock trial protocols, dosing has been implemented as:
- Initial IV bolus 2 mg/kg, followed by 1 mg/kg IV every 6 hours until predefined stability criteria were met. [2]
Treatment Duration and Discontinuation Principles
Hydrocortisone dosing in trials continues until clinical stability criteria are met rather than as a fixed-length course. [2]
Sources
[1] Texas Children’s Hospital Evidence-Based Outcomes Center. Septic Shock Guideline (FINAL-092021). September 2021. [1]
[2] A Randomized Controlled Trial of Corticosteroids in Pediatric Septic Shock: A Pilot Feasibility Study. (Trial protocol dosing schedule described in the publication.) [2]