Endocrine Drugs

Steroids

 

General

The use of steroids in the critically ill has been the subject of much debate and some research.

Steroids should not be prescribed by registrars, except for those indications listed below as proven, unless this has first been discussed with the duty intensive care specialist.

Proven Indications:

  • Hypoadrenalism (Addison's disease or crisis)
  • Acute severe asthma
  • Panhypopituitarism
  • Haemophilus meningitis in children (discuss with paediatric team first)
  • Pneumocystis Carinii pneumonia (paO2 < 60 mmHg)
  • Collagen vascular diseases
  • Active Immunosuppression (GVHD, solid organ transplant)
  • Myasthenia gravis

 

Unproven Intensive Care Unit Indications

  • Non-infected (fibroproliferative) ARDS: Meduri protocol = Methylprednisolone 2 mg/kg for 14 days, tapered 1.0-0.5 mg/kg for next 14 days
  • Shock associated with vasodilated states which are refractory to high dose, or prolonged administration of, inotropes
  • Myocarditis
  • Exacerbation of chronic airway obstruction
  • Bronchiolitis obilterans
  • Reduction of cerebral oedema around traumatic CNS lesions
  • Anaphylaxis

 

Conditions where Steroids are not Indicated or Actively Contra-Indicated

  • Active infection
  • Acute head injury
  • Guillain-Barre syndrome

 

Relative Steroid Potencies

SteroidEquivalence (mg)Glucocorticoid ActivityMineralocorticoid Activity
Hydrocortisone100 mg11
Prednisone2540.3
Methylpred2040
Dexamethasone4  
Fludrocortisone110250

 

Apache II Co-morbidity – 15mg/kg/day of Methylprednisolone for 70kg  1gm = 5,000mg hydrocortisone

Page last reviewed: 13 May 2014
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