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Critical illness-related corticosteroid insufficiency

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of critical illness-related corticosteroid insufficiency are prepared by our editorial team based on guidelines from the Surviving Sepsis Campaign (SSC 2021), the Infectious Diseases Society of America (IDSA/ATS 2019), the British Medical Journal (BMJ 2018), the European Association for the Study of the Liver (EASL 2018), and the European Society of ...
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Diagnostic investigations

Adrenal function testing: as per ESICM/SCCM 2017 guidelines, insufficient evidence to recommend whether to use delta cortisol (change in baseline cortisol at 60 mins of < 9 µg/dL) after cosyntropin (250 µg) administration or random plasma cortisol of < 10 µg/dL for the diagnosis of critical illness-related corticosteroid insufficiency.
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Medical management

Corticosteroid administration, sepsis: as per SSC 2021 guidelines, consider administering IV corticosteroids in adult patients with septic shock and an ongoing requirement for vasopressor therapy.
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More topics in this section

  • Corticosteroid administration (pneumonia)

  • Corticosteroid administration (ARDS)

  • Corticosteroid administration (meningitis)

  • Corticosteroid administration (major trauma)

  • Corticosteroid administration (cardiopulmonary bypass surgery)

  • Corticosteroid administration (cardiac arrest)

Specific circumstances

Patients with liver cirrhosis: as per EASL 2018 guidelines, diagnose relative adrenal insufficiency based on a delta serum total cortisol of < 248 nmol/L (9 µg/dL) after 250 µg corticotropin injection or a random total cortisol of < 276 nmol/L (< 10 µg/dL).
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