10
Treatment
Table 3. Management of PAI in Specific Situations
Condition Suggested Action
Home management of
illness with fever
Hydrocortisone replacement doses doubled (>38°C) or
tripled (>39°C) until recovery (usually 2–3 d); increased
consumption of electrolyte-containing fluids as tolerated
Unable to tolerate oral
medication due to
gastroenteritis or trauma
Adults: IM or subcut hydrocortisone 100 mg
Adolescents: 100 mg
School-age children: 50 mg
Children: IM hydrocortisone 50 mg/m
2
or estimate
Infants: 25 mg
Minor to moderate surgical
stress
Hydrocortisone, 25–75 mg/24 h (usually 1–2 d)
Children: IM hydrocortisone 50 mg/m
2
or
hydrocortisone replacement doses doubled or tripled
Major surgery with general
anesthesia, trauma, delivery,
or disease that requires
intensive care
Hydrocortisone, 100 mg per IV injection followed by
continuous IV infusion of 200 mg hydrocortisone/24h
(alternatively 50 mg q6h IV or IM)
Children: hydrocortisone 50 mg/m
2
IV followed by
hydrocortisone 50–100 mg/m
2
/d divided q6h
Weight-appropriate continuous IV fluids with 5%
dextrose and 0.2 or 4.5% NaCl
Rapid tapering and switch to oral regimen depending on
clinical state
Acute adrenal crisis Rapid infusion of 1000 mL isotonic saline within the
first hour or 5% glucose in isotonic saline, followed
by continuous IV isotonic saline guided by individual
patient needs
Hydrocortisone 100 mg IV immediately followed by
hydrocortisone 200 mg/d as a continuous infusion for 24 h,
reduced to hydrocortisone 100 mg/d the following day
Children, rapid bolus of normal saline (0.9%) 20 mL/kg.
Can repeat up to a total of 60 mL/kg within 1 h for shock.
Children, hydrocortisone 50–100 mg/m
2
bolus followed
by hydrocortisone 50–100 mg/m
2
/d divided q6h
For hypoglycemia: dextrose 0.5–1 g/kg of dextrose or
2–4 mL/kg of D25W (maximum single dose 25 g )
infused slowly at rate of 2–3 mL/min. Alternatively,
5–10 mL/kg of D10W for children <12 y old
Cardiac monitoring : Rapid tapering and switch to oral
regimen depending on clinical state
Adapted from B. Allolio: Extensive expertise in endocrinolog y: adrenal crisis.
Eur J Endocrinol. 2015;172:R115–R124 (126), with permission. © Endocrine Society.
