ANSWER TO QUIZ OF THE WEEK: MARCH 18, 2005
Hydrocortisone 100 mg q8h is sufficient to provide cortisol and aldosterone replacment. Adrenal insufficiency is common in septic shock. Cortisol is needed to make blood vessels responsive to catecholamines and for conversion of stored fuel to glucose.
In the study by Annane (2002), 8 patients with septic shock needed to be treated with steroids to save one additional life. Hydrocortisone 50 mg IV q6h plus fluodrocortisone 50 ug tab were given to patients with septic shock.
Annane, D. et al. (2002). Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 288(7): 262-871.
Bollaert, P., Charpentier, C., Levy, B., Debouverie, M., Audibert, G., and Larean, A. (1998). Reversal of later septic shock with supraphysiologic doses of hydrocortisone. Crit Care Med. 26: 645-650
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Critical Care Trauma Centre