Mineralocorticoids in Pediatric Practice
Mineralocorticoids in Pediatric Practice
Mineralocorticoids are crucial steroid hormones that regulate electrolyte and fluid balance in pediatric patients. They primarily act on the distal tubules and collecting ducts of the kidney to promote sodium reabsorption and potassium excretion.
Key Points
- Primary indication: Adrenal insufficiency
- Critical for maintaining sodium-potassium balance
- Essential in managing congenital adrenal hyperplasia (CAH)
- Careful monitoring required due to narrow therapeutic window
Physiological Role
- Regulation of blood pressure
- Maintenance of plasma sodium and potassium levels
- Control of blood volume and fluid balance
- Impact on cardiovascular function
Fludrocortisone (Florinef)
Drug Information
- Available forms: 0.1 mg tablets
- Half-life: 18-36 hours
- Bioavailability: 100%
Dosing Guidelines
- Neonates: 0.05-0.2 mg/day
- Infants and Children: 0.05-0.3 mg/day
- Adolescents: 0.05-0.4 mg/day
- Usually divided into 1-2 doses daily
Monitoring Parameters
- Blood pressure (target: age-appropriate normal range)
- Serum electrolytes (Na+, K+)
- Plasma renin activity
- Growth velocity in children
- Body weight and edema
Common Side Effects
- Hypertension
- Edema
- Hypokalemia
- Growth suppression (at higher doses)
Desoxycorticosterone Pivalate (DOCP)
Characteristics
- Long-acting mineralocorticoid
- Injectable formulation
- Duration of action: 3-4 weeks
Clinical Applications
- Alternative to oral fludrocortisone
- Used in cases of poor medication adherence
- Beneficial in malabsorption syndromes
Administration
- Intramuscular injection only
- Dosing interval: Every 3-4 weeks
- Dose individualization required
Clinical Applications and Management
Primary Indications
- Congenital Adrenal Hyperplasia (CAH)
- Addison's Disease
- Salt-wasting disorders
- Secondary adrenal insufficiency
Emergency Management
- Adrenal crisis requires immediate intervention
- IV hydrocortisone is the primary treatment
- Fluid resuscitation with normal saline
- Close monitoring of vital signs and electrolytes
Practice Pearls
- Stress dosing needed during illness or surgery
- Regular monitoring of growth and development
- Patient/family education crucial for compliance
- Medical alert bracelet recommended
