Corticosteroid Replacement in Critically Ill Patients

Corticosteroid Replacement in Critically Ill Patients -...

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Corticosteroid Replacement Corticosteroid Replacement in Critically Ill Patients in Critically Ill Patients Deepika Nehra, MSIV Trauma Conference July 10 th 2006
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Steroid Physiology Steroid Physiology
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Basal Cortisol Production = 8-25 mg in 24hrs Production can be increased 6-fold in stress Diurnal pattern of cortisol production lost in stress situations Cortisol T 1/2 = 70-120 minutes Bound to circulating CBG, albumin, α 1-acid glycoprotein 10% free = biologically active CBG decreases rapidly in critically ill pts increased free cortisol
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Adrenal Insufficiency (AI) Adrenal Insufficiency (AI) 1. Primary Adrenal Insufficiency (Addison’s) >90% destruction of adrenal cortex Causes: thrombosis, hemorrhage (septic shock with DIC), necrosis from ischemia Sxs: truncal pain, fever, shaking chills, hypotension, shock, abdominal rigidity or rebound, dehydration, hyponatremia, hyperkalemia, elevated BUN Failure to recognize and tx severe adrenal insufficiency (addisonian crisis) can be fatal within 6-48 hours
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Adrenal Insufficiency (AI) Adrenal Insufficiency (AI) 2. Secondary Adrenal Insufficiency Pituitary or hypothalamic abnormalities Causes: empty sella syndrome, tumors, hypopituitarism, head trauma, postpartum pituitary necrosis, exogenous glucocorticoid use Sxs: similar to primary AI but with preserved aldosterone (no Na, K abnormalities)
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Adrenal Insufficiency (AI) Adrenal Insufficiency (AI) 3. Relative or Functional AI
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Corticosteroid Replacement in Critically Ill Patients -...

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