Fluids for Septic shock
This algorithm shows the suggested response to managing each step of a patient with septic shock. The timeline assumes inadequate resonse to treatment at each step.
The algorithm is based on the one produced by the Surviving Sepsis Campaign
Steroids in sepsis
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To be considered as a rescue therapy by the PICU Consultant in patients with:
- Septic shock and
- Ongoing fluid requirement and
- Increased inotropic support
- Perform a random Cortisol level prior to commencing steroids
- Hydrocortisone (HC) should be used rather than Dexamethasone
- There are no indications for high dose steroids in sepsis
- Stress doses should be used: HC 30 mg/m2/day IV divided 6 hourly
- Stop steroids if Cortisol level >500nmol/l
- Steroids should be weaned once patient has improved and off inotropes
- Involve endocrinology if any suspicion of adrenal insufficiency as an underlying diagnosis.
A normal stress response in meningococcal disease is a CORTISOL VALUE ON ADMISSION > 950 NMOL/L.
RELATIVE ADRENAL INSUFFICIENCY IS DEFINED AS A RANDOM CORTISOL LEVEL < 500 NMOL/L
