Decadron (Dexamethasone) IM Dosing for Pediatric Patients
For most pediatric conditions requiring intramuscular dexamethasone, use 0.6 mg/kg (maximum 8-10 mg) as a single dose, though life-threatening conditions like adrenal crisis require substantially higher dosing at 2-3 mg/kg (maximum 100 mg). 1, 2, 3
Condition-Specific IM Dosing
Life-Threatening Conditions (Adrenal Insufficiency/Crisis)
- Initial dose: 2-3 mg/kg IM (maximum 100 mg) administered over 3-5 minutes 1, 2
- Maintenance: 1-5 mg/kg every 6 hours for infants OR 12.5 mg/m² every 6 hours for older children 1, 2
- Critical caveat: Do not underdose in adrenal crisis - strongly consider concomitant fluid bolus of 20 mL/kg of D5NS or D10NS during first hour 1, 2
Moderate Inflammatory Conditions (Croup, Asthma Exacerbations)
- Standard dose: 0.6 mg/kg IM (maximum 8 mg) as single dose 4, 5, 6
- Alternative dosing: Some protocols use approximately 1.7 mg/kg for asthma exacerbations 4
- This single IM dose is equally effective as 5 days of oral prednisone for mild-moderate asthma and croup 4, 5, 6
- Approximately 70% of parents prefer IM dexamethasone over multi-day oral steroids due to compliance issues 4
Perioperative/Adjunctive Use
- Dose: 0.5 mg/kg IM (maximum 8-25 mg) for single perioperative doses 2
- Used for reducing postoperative nausea/vomiting and throat pain in tonsillectomy 2
Route Considerations and Practical Points
When to Choose IM Over Other Routes
- IM is appropriate when IV access is unavailable or for single-dose emergency treatment 2
- IM is less preferred than IV for titration purposes but avoids compliance issues with oral dosing 2, 4
- The injection causes minimal complications when properly administered 4
Age-Specific Considerations
- Smallest effective dose should be used in children, preferably oral when possible 3
- Pediatric dosing may approximate 0.2 mg/kg/24 hours in divided doses for chronic conditions 3
- For acute conditions, single higher doses (0.6 mg/kg) are standard 4, 5, 6
Common Pitfalls and Contraindications
Critical Warnings
- Exclude patients with endocrine disorders already receiving exogenous steroids 2
- Use caution in diabetic patients due to glucose-insulin regulation interference 2
- Never underdose in life-threatening adrenal crisis - this is a fatal error 1, 2
Administration Technique
- Inject into anterolateral thigh for infants/young children or deltoid for older children 1
- Injection site pain is the primary disadvantage compared to IV route 2
- No protective measures needed (unlike light-sensitive medications) 1
Clinical Decision Algorithm
Step 1: Identify severity
- Life-threatening (shock, adrenal crisis) → 2-3 mg/kg IM (max 100 mg) 1, 2
- Moderate inflammatory (croup, asthma) → 0.6 mg/kg IM (max 8 mg) 4, 5, 6
Step 2: Assess IV access
- No IV access + acute condition → IM is preferred route 2
- IV available + need for titration → IV preferred over IM 2
Step 3: Consider compliance factors