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This article is part of the supplement: 34th International Symposium on Intensive Care and Emergency Medicine

Open Access Poster presentation

Continuous administration of corticosteroids in septic shock can reduce risk of hypernatremia

L Mirea1*, R Ungureanu1, D Pavelescu1, IC Grintescu1, C Dumitrache2, I Grintescu1 and D Mirea3

  • * Corresponding author: L Mirea

Author Affiliations

1 Clinical Emergency Hospital of Bucharest, Romania

2 CI Parhon National Institute of Endocrinology, Bucharest, Romania

3 Elias University Emergency Hospital, Bucharest, Romania

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Critical Care 2014, 18(Suppl 1):P239  doi:10.1186/cc13429


The electronic version of this article is the complete one and can be found online at: http://ccforum.com/content/18/S1/P239


Published:17 March 2014

© 2014 Mirea et al.; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Introduction

Although the administration of hydrocortisone in septic shock generates adverse effects, the risk of corticosteroid-induced hypernatremia may be reduced by continuous administration of the drug [1][2].

Methods

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.

Results

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).

Conclusion

Continuous administration of hydrocortisone hemi- succinate in septic shock is associated with a lower risk of hypernatremia than bolus administration.

References

  1. Sprung CL, Annane D, Keh D, et al.: Hydrocortisone therapy for patients with septic shock.

    N EnglJ Med 2008, 358:111-124. Publisher Full Text OpenURL

  2. Annane D, Bellissant E, Bollaert PE, et al.: Corticosteroids in the treatment of severe sepsis and septic shock in adults: a systematic review.

    JAMA 2009, 301:2362. PubMed Abstract | Publisher Full Text OpenURL