BSPED2022 Poster Presentations Adrenal 1 (6 abstracts)
Recommendations for hydrocortisone doses for emergency management and peri-operative care for childhood adrenal insufficiency. BSPED consensus guidelines
Talat Mushtaq 1 , Salma Ali 2,3 , Nabil Boulos 4 , Roisin Boyle 2 , Tim Cheetham 5 , Justin Davies 4 , Charlotte Elder 6 , Hoong-Wei Gan 7 , Peter Hindmarsh 8 , Harshini Katugampola 7 , Stephanie Kerr 4 , Nils Krone 9 , Maria Salomon Estebanez 10 , Savitha Shenoy 11 , Sally Tollerfield 7 , Sze Choong Wong 2,3 & Fiona Regan 12
1Leeds Children’s Hospital, Leeds, United Kingdom; 2Royal Hospital for Children, Glasgow, United Kingdom; 3University of Glasgow, Glasgow, United Kingdom; 4Southampton University Hospitals NHS Foundation Trust, Southampton, United Kingdom; 5Great North Children’s Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom; 6Sheffield Children’s NHS Foundation Trust, Sheffield, United Kingdom; 7Great Ormond Street Hospital for Children, London, United Kingdom; 8UCL Institute of Child Health, London, United Kingdom; 9University of Sheffield, Sheffield, United Kingdom; 10Royal Manchester Children’s Hospital, Manchester, United Kingdom; 11University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; 12Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
Adrenal insufficiency (AI) is characterised by lack of cortisol production from the adrenal glands which is treated with replacement doses of hydrocortisone. At times of physiological stress there is an increased requirement for exogenous glucocorticoids, which if untreated can lead to an adrenal crisis. Currently there are no unified guidelines for those <18 years old in the UK; this can lead to a substantial variation in the management of AI in both an emergency and peri-operative situation. The Paediatric AI Group (17 professionals from nine centres including paediatric endocrinologists, specialist nurses and a pharmacist) was set up in 2021 under the auspices of the BSPED to provide national guidance. For sick days the preferred consensus option is approximately 30 mg/m2/day hydrocortisone given as 4 equally divided doses for moderate to severe illness. This allows accuracy of dosing at regular 6 hourly intervals. In acute situations the emergency dose of intramuscular hydrocortisone is 25 mg <1 year, 50 mg 1 to 5 years and 100 mg ≥6 years, followed by 2 mg/kg (max 100 mg) (neonates 4 mg/kg) IV initially 4 to 6 hourly, then reduced to 1 mg/kg (max 50 mg) (neonates 2 mg/kg) IV 6 hourly when stable before switching to oral sick day hydrocortisone. For surgical procedures a bolus of hydrocortisone 2 mg/kg (neonates 4 mg/kg) (max 100 mg) is required at induction for general anaesthetic. This is followed by either a) a hydrocortisone infusion based on the weight of the child (<10 kg 25 mg in 24 hours; 10.1 to 20 kg 50 mg in 24 hours; 20.1 to 40 kg 100 mg in 24 hours, 40.1 to 70 kg 150 mg in 24 hours, over 70 kg 200 mg in 24 hours) or b) hydrocortisone IV boluses 1 mg/kg (neonates 2 mg/kg) (max 50 mg) every 6 hours. If required, during prolonged operations or if unstable, the initial bolus dose can be repeated at a 4 to 6 hour intervals. In severe obesity 100 mg of hydrocortisone can be given every 6 hours. The broad management principles from this group will be used to create documents on sick day steroid recommendations, standardised surgery advice, a new BSPED emergency card, a publication, on-going training and education and engagement with support groups and professional societies.
Volume 85
Article tools
My recent searches
My recently viewed abstracts
Authors
Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
© Bioscientifica 2024 |
Privacy policy |
Cookie settings
BiosciAbstracts
Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences.
Find out more