stress dose steroids

8 May

RAGING HYPOTHETICAL:
–septic patient
–poured in lots of fluid, still hypotensive
–dripping in lots of pressors, still hypotensive
–um, what now?




POSSIBLE OPTION: STEROIDS (quick hits)
–‘stress dose’ steroids have been used for fluid/pressor unresponsive patients in septic shock


hydrocortisone 50mg IV q6h, or 100mg IV bolus + drip (adults)


–not highly recommended in kids, unless known adrenal insufficiency
–rule of thumb stress dose for those on chronic steroids: 2-3x normal daily dose


–seems to have quicker resolution of shock, but not much mortality benefit


–slow taper later (thanks for taking care of this, ICU colleagues)




Reference(s): surviving sepsis recs, meta-analysis, uptodate.com: Hydrocortisone (systemic): Drug information, Corticosteroid therapy in septic shock, picture

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