Commonly, the recommended dose of hydrocortisone is 50 mg/m2. Measuring the m2 is a reflection of the Body Surface Area (BSA), which in the acute setting, such as the emergency department, it can be difficult to calculate.
Dr. Sonny Tat (UCSF Assistant Professor of EM and Pediatrics) remembers it by thinking about the loose change in his pocket. The Coin Mnemonic which allows you to quickly estimate the initial stress dose of hydrocortisone. Check out the 2-minute Trick of the Trade video, if you are a visual learner.
Animated Video on Hydrocortisone Stress-Dosing (Trick of the Trade)
- For small-sized kids (neonates to 3 years old), give 25 mg IV/IM (or think of a quarter)
- For medium-sized kids (3-12 years old), give 50 mg IV/IM (or think of a half-dollar)
- For large-sized kids (12+ years old), give 100 mg IV/IM (or think of a dollar coin).
For further detail, you can also check out CHOP’s algorithm for treating pediatric patients in adrenal crisis.
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