Dexamethasone Pediatric Dose Calculator

The Dexamethasone Pediatric Dose Calculator is a simple online calculator designed to help health professionals calculate the appropriate recommended dose of dexamethasone (DXM) for children. 

The tool allows you to calculate dexamethasone doses for specific indications such as airway edema, croup, inflammation, meningitis, and spinal cord compression. 

How to Use This Calculator

1. Enter the weight of the child either in kilograms or pounds and select the applicable unit.
2. Select the Indication for which Dexamethasone is prescribed.
3. Click the Calculate Dose button for your recommended dose to be calculated.

What Is Dexamethasone?

Dexamethasone is a potent synthetic corticosteroid drug with powerful anti-inflammatory and immunosuppressant effects. It was first developed in 1957 and approved for medical use in 1958. Today, dexamethasone remains one of the most widely prescribed corticosteroid medications.

Chemically, dexamethasone is similar to the body’s natural corticosteroid hormones produced in the adrenal gland. But it has about 25 times more anti-inflammatory potency than the corticosteroid hydrocortisone. This makes it very effective at reducing inflammation in many medical conditions.

Dexamethasone comes as a tablet, oral solution, eye drops, topical creams/ointments, injectable solution, and more. The dose varies greatly depending on the condition being treated.

Mechanism of Action 

Like other corticosteroids, dexamethasone works by mimicking the effects of the body’s natural corticosteroid hormones. It binds to steroid receptors and reduces inflammation through multiple mechanisms, including reducing cytokine production, leukocyte migration, and through immunosuppressive effects.

Uses 

It is used to treat a wide variety of inflammatory and autoimmune conditions. This includes

• Treating inflammatory conditions: multiple sclerosis flares, allergies, inflammation, shock, asthma, skin conditions like dermatitis, and drug hypersensitivity reactions.
• Endocrine uses: dexamethasone can be used as a test for Cushing’s syndrome.
• Neurological uses: dexamethasone is used to treat cerebral edema (brain swelling).
• Cancer uses: dexamethasone treats chemotherapy side effects like nausea/vomiting and spinal cord compression from metastases.
• Infectious disease uses: dexamethasone is recommended for severe COVID-19 patients requiring respiratory support.

Side Effects 

Potential side effects of dexamethasone include the following:

• Insomnia
• Fluid retention
• Electrolyte imbalances
• Weight gain
• Increased appetite
• Anorexia
• Nausea
• Vomiting
• Acne
• Agitation
• Depression
• Adrenal suppression
• Arrhythmias
• Spermatogenic changes
• Glaucoma
• Hypokalemia
• Pulmonary edema
• Pseudotumor cerebri
• Increased intracranial pressure
• Steroid-induced osteonecrosis of the femoral head
• Hepatotoxicity and liver injury (at high doses)

Contraindications

Dexamethasone is not to be used in patients with certain conditions. Some situations also require cautious use. Below are the contraindications for dexamethasone.

Absolute Contraindications:

• Known hypersensitivity: Patients with a history of allergic reaction or anaphylaxis to dexamethasone should avoid it.
• Systemic fungal infections: Dexamethasone further suppresses the immune system, risking disseminated fungal infections from candida, cryptococcus, histoplasmosis and others that can be life-threatening.
• Administration of live vaccines: The impaired immune response can increase risk of infections from live vaccines like MMR, varicella, rotavirus, and intranasal influenza. Inactivated vaccines may not be as effective either.

Relative Contraindications (use caution):

• Pregnancy: Dexamethasone crosses the placenta and is associated with an increased risk of oral clefts and other abnormalities in the fetus. Should be avoided unless the benefit clearly outweighs the fetal risk.
• Cirrhosis and GI conditions like diverticulitis, ulcerative colitis, or peptic ulcers: Increased likelihood of perforation with dexamethasone’s impacts on wound healing.
• Diabetes: Dexamethasone can markedly increase blood glucose which can be problematic to control in diabetic patients. Close monitoring is required.
• Osteoporosis: Increased bone loss, higher fractures. Caution in elderly and those with other osteoporosis risks. Calcium/Vitamin D supplementation should be considered.
• Abrupt discontinuation: Slow taper is vital to allow adrenal axis recovery, avoiding adrenal crisis risks.

References

1. Medscape: Dexamethasone Rx
2. Johnson DB, Lopez MJ, Kelley B. Dexamethasone. [Updated 2023 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.