Corticosteroid use in septic shock

Dexamethasone is given systemically to decrease inflammatory and immune responses. It is used in high doses in emergencies for anaphylactic reactions, spinal cord trauma or shock. It is used in lower doses to treat allergic reactions such as Chronic Obstructive Pulmonary Disease (COPD), hives, itching, inflammatory diseases including arthritis and to manage and treat immune mediated hemolytic anemia and thrombocytopenia. It sometimes is used systemically as a "performance-enhancing” drug because corticosteroids decrease inflammation, possibly enhance glucose metabolism (there is some debate about this) and may have some mood elevating properties. Other corticosteroids are preferred for intra articular use.

Plasma cortisol and adrenocorticotrophin hormone (ACTH) profiles were estimated in twelve patients with Addison's disease following randomized oral administration of either cortisone acetate (25 mg) or hydrocortisone (20 mg) alternately, at 0900 h on consecutive days. Normal corticosteroid replacement therapy was discontinued from 1200 h on the day prior to the study period. In four patients elevated basal plasma ACTH concentrations were not suppressed to the limit of detection following the administration of either drug, and in three of these no suppression was found following the prolonged administration of pharmacological doses of dexamethasone. Diminished sensitivity of pituitary ACTH secretion to cortisol inhibition may result from chronic loss of negative feedback before and/or after diagnosis and treatment. In three patients elevated basal plasma ACTH concentrations were suppressed adequately during the administration of either drug, but in five, low basal ACTH concentrations following corticosteroid withdrawal suggested chronic inhibition of anterior pituitary corticotrophs by over-replacement with glucocorticoid. However, further study is necessary to determine whether the estimation of ACTH profiles is a more accurate reflection of the adequacy of corticosteroid replacement than the estimation of cortisol profiles alone, and whether this estimation leads to an improvement in patient management. Hydrocortisone (20 mg) achieved higher mean cortisol levels and lower mean ACTH levels than cortisone acetate (25 mg), but either drug may be suitable for glucocorticoid replacement provided the dose is tailored to the individual needs.

Lotemax is used in dry eye syndrome to decrease and eliminate inflammation of the ocular surface caused by the hyperosmolarity of the tears.  The inflammation must first be brought under control before any other treatments can be optimally effective.  Lotemax would typically be prescribed for two weeks to three months initially and then may need to be used again on a 1-2 week regimen periodically if the inflammation occurs again.  Lotemax ointment has become a choice of many doctors to treat inflammation caused by dry eye (ocular surface disease) because it can be used at night with a long contact period to the eye's surfaces and provide some functional lubrication while the eyes are closed.

Corticosteroid use in septic shock

corticosteroid use in septic shock

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