stress dose steroids

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