IV Corticosteroid / Adrenal Replacement
Pregnancy: Compatible — hydrocortisone is the replacement steroid of choice in pregnancy (prednisolone preferred for anti-inflammatory use)
Hydrocortisone (IV — Paediatric Emergency)
Brand names: Solu-Cortef
Adult dose
Dose: Adrenal crisis: 100 mg IV bolus then 200 mg/24h infusion. Status asthmaticus: 200 mg IV QDS.
Route: IV
Frequency: Single bolus + infusion (adrenal crisis); QDS (asthma)
Max: 100 mg per bolus
Full adult dosing in endocrinology section
Paediatric dose
Route: IV
Frequency: Every 6 hours (QDS) for crisis; single dose for asthma/anaphylaxis
Max: 100 mg per dose
Concentration: 100 mg/mL (Solu-Cortef Act-O-Vials) mg/ml
BNF for Children — age-banded fixed doses (adrenal crisis IV bolus): neonate/infant <1 yr: 25 mg; 1–5 yr: 50 mg; 6–12 yr: 50–100 mg; >12 yr: 100 mg. Maintenance: 2 mg/kg/day IV in 4 divided doses. Asthma/anaphylaxis: 4 mg/kg IV (max 200 mg). Weight-based calculator not applicable — use age-banded doses above. Source: BNF for Children 2024; BSPED; Society for Endocrinology Emergency Guidelines
Dose adjustments
Renal
No dose adjustment required
Hepatic
No dose adjustment required
Clinical pearls
- Adrenal crisis in known CAH: give appropriate stress dose immediately — do NOT delay for investigations
- IM preparation (emergency kit): all CAH/Addison's patients should have Solu-Cortef emergency kit at home (100 mg IM)
- Sick day rules for all patients on corticosteroid replacement therapy: double oral dose for minor illness; IM injection if vomiting or unable to take orally
- Weaning after acute use: reduce back to physiological replacement dose over 24–72h to avoid HPA suppression
Contraindications
- Systemic fungal infection (without antifungal cover)
Side effects
- Hyperglycaemia
- Electrolyte disturbances
- Immunosuppression
- Fluid retention
Interactions
- NSAIDs — GI bleeding risk
- Antidiabetics — increased dose requirements
Monitoring
- Blood glucose
- Serum electrolytes
- Blood pressure
- Signs of infection
Reference: BNF for Children; BSPED Guidelines; Society for Endocrinology Emergency Guidelines. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators