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Reviews:
Peter C. Minneci, Katherine J. Deans, Steven M. Banks, Peter Q. Eichacker, and Charles Natanson

Meta-Analysis: The Effect of Steroids on Survival and Shock during Sepsis Depends on the Dose
Ann Intern Med 2004; 141: 47-56 [Abstract] [Full text]

Electronic letters published:

Low dose steroids stabilizes patient in sepsis.

Enrique J. Sánchez-Delgado, Marvin Mayorga, Erwin Plata, Josè A. Montiel, Daniel Meneses (12 July 2004)

Low dose steroids stabilizes patient in sepsis.

12 July 2004

Enrique J. Sánchez-Delgado,
M.D., Prof. Dr. med.
Hospital Metropolitano Vivian Pellas, Managua, Nicaragua,
Marvin Mayorga, Erwin Plata, Josè A. Montiel, Daniel Meneses

Send rapid response to journal:
Re: Low dose steroids stabilizes patient in sepsis.

Email Enrique J. Sánchez-Delgado,, et al.

Short after the inauguration of the Hospital Metropolitano Vivian Pellas in Managua, a 75 years old lady was received in the ER presenting chills, myalgias, hypotension and anuria, as well as low oxygen saturation, tachypnea and rales. She had been in treatment for congestive heart failure and atrial fibrillation, but presented with sinus rythmus. She had a plasty repair three years ago in USA for a mitral regurgitation, and the valve was fibrotic and calcified, difficulting the echo diagnosis for endocarditis. There was a marked leucocytosis, with left deviation and toxic granulations of the leucocytes, markedly elevated CRP and elevated creatinine. Both ACS or AMI were ruled out.

She was admitted to the ICU and treated for sepis, probable endocarditis, congestive heart failure and pre-renal renal failure.

Despite restoration of renal function, clearing of lung parenchima, recovering of oxygen saturation and appropiate antibiotic treatment, the hemodynamic pharmacologycal support with dopamine/dobutamine and properly regulated fluids were not enough to keep her blood pressure stable, and she had frecuent hypotensive episodes.

At the third day we decided to start with low dose hydrocortisone, 100 mg i.v. every 8 hours. She stabilized and could be continued with 100 mg a day until her release at the 8th. day with all her organ functions normalized to continue her treatment ambulatory, under supervision of her cardiologist. Conflict of Interest: None declared