Tuesday, January 22, 2008

Tuesday January 22, 2008

Q: Why (Dexamethasone) decadron is not a good choice of steroid in septic shock unless untill absolutely necessary?

Answer: Reasons which render dexamethasone a poor choice in ICU particularly in sepsis are:

1. It has very minimal (almost negilgible) mineralocorticoid activity. Advantage of performing ACTH stimulation test, while on decadron is there but again its no more recommended to perform in septic shock per updated guidelines of Surviving Sepsis Campaign 1. It is suggested to give IV hydrocortisone to adult septic shock patients if blood pressure remains poorly responsive to fluid resuscitation and vasopressor therapy (grade 2C) - without ACTH stimulation test. Potency of Hydrocortisone and Dexamethasone is 20:1 - means 1 mg of dexamethasone is equal to 20 mg of hydrocortisone.

2. It has prolog half life of 36-54 hours. In updated guidelines of Surviving Sepsis Campaign 1, it is Grade 2B recommendation that patients with septic shock should not receive dexamethasone if hydrocortisone is available. As dexamethaxone has no mineralcorticoid activity, in case if used, should be use with florinef (fludrocortisone).

3. Dexamethasone can lead to immediate and prolonged suppression of the hypothalamic-pituitary-adrenal axis after administration 2.

Reference: click to get abstract

1. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008 - Critical Care Medicine:Volume 36(1)January 2008pp 296-327
The hypothalamic-pituitary-adrenal axis in critical illness: Response to dexamethasone and corticotropin-releasing hormone. J Clin Endocrinol Metab 1993; 77:151-156

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