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Aneja and Carcillo’s review of adrenal insufficiency and the rationale for steroid use in sepsis is both concise and timely.1 Although they acknowledge that further studies are needed in paediatrics before recommending a 7 day course of hydrocortisone in catecholamine resistant septic shock, they suggest that the logic for this therapy is “compelling”, recommending a bolus of hydrocortisone followed by an infusion of up to 50 mg/kg/day in states of sepsis-induced relative adrenal insufficiency.
This compelling logic is incorporated within their statement that, among children with septic shock, survivors exhibit dramatically increased plasma levels of cortisol compared to non-survivors (Aneja and Carcillo, …
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