stress dose steroids

8 May

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

–‘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, Hydrocortisone (systemic): Drug information, Corticosteroid therapy in septic shock, picture


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