A total of 171 patients with septic shock were randomized into three study groups: group A (n = 58), 200 mg/day hydrocortisone hemisuccinate in four doses; group B (n = 59), same dose of hydrocortisone hemisuccinate in continuous administration; group C (n = 54), no hydrocortisone hemisuccinate. Mean serum sodium values, the number of hypernatremia episodes and variations in serum sodium (Na var) were investigated for 7 days. The local ethics committee approved the study.
There were no differences between the three groups at the beginning of the study regarding demographic data and the clinical characteristics. Mean values of natremia were normal in group C (140.35 ± 7.390 mEq/l to 144.79 ± 8.338 mEq/l) during the study period. High mean values appeared on day 4 in group A (147.21 ± 8.470 mEq/l to 149.37 ± 8.973 mEq/l on day 7) and on day 5 in group B (146.36 ± 8.272 mEq/l to 147.70 ± 8.865 mEq/l). Na var was 8.59 ± 5.960 mEq/l (-8 and 21 mEq/l) in group A, 6.63 ± 7.609 mEq/l (-17 and 23 mEq/l) in group B and 4.54 ± 7.455 mEq/l (-12 and 22 mEq/l) in group C. This variation is statistically significant when groups A and B are compared with group C (P = 0.012) and when only group A is compared with group C (P = 0.0019). The risk of hypernatremia after hydrocortisone hemisuccinate was almost three times higher than that of patients who did not receive this drug (RR 2.82, 1.35 <OR <5.90, P = 0.0041) and slightly higher when HHS was delivered as a bolus (RR 3.08, 1.32 <OR <7.25, P = 0.0071).
Continuous administration of hydrocortisone hemi- succinate in septic shock is associated with a lower risk of hypernatremia than bolus administration.
N EnglJ Med 2008, 358:111-124. Publisher Full Text