High dose steroids sepsis

In an animal models, administration of ascorbic acid has been demonstrated to produce an antidepressant-like effect mediated by interaction with the monoaminergic and GABAa systems.[64,65] Gariballa evaluated the clinical significance of vitamin C deficiency among hospitalized acutely-ill older patients.[66] In this study patients with vitamin C biochemical depletion had significantly increased symptoms of depression compared with those with higher concentrations at baseline and at 6 weeks. In a randomized controlled trial, Zhang et al demonstrated that 500 mg vitamin C PO BID improved the mood and decreased depression symptoms in a cohort of acutely hospitalized patients.[67]  In a  randomized double-blind, placebo-controlled 14 day trial, Brody demonstrated that oral vitamin C resulted in a decrease in the Beck Depression scores with improved sexual intercourse frequency.[68]  A randomized, double-blind, placebo-controlled study in pediatric patients demonstrated that ascorbic acid was an effect adjunct to fluoxetine in the treatment of major depression.[69] We therefore propose/hypothesize that treatment with vitamin C during the acute phase of illness may limit the incidence and or severity/duration of delirium which may then limit or prevent the long-term neuro-psychiatric complications of sepsis.  Furthermore, as treatment with the vitamin C cocktail reduces the duration of mechanical ventilation, duration of vasopressor support and duration of ICU stay we postulate that this intervention may promote early mobility and limit muscle loss thereby limiting critical illness myopathy (CIM) characteristic of critical illness and sepsis.

Initially, 1 to mg/kg IV. If ventricular fibrillation or pulseless ventricular tachycardia persist, additional to mg/kg IV doses can be given every 5 to 10 minutes up to a total loading dose of 3 mg/kg. The same dose may be given via the intraosseous route when IV access is not available. There is inadequate evidence to support the routine use of lidocaine after cardiac arrest; however, the initiation or continuation of lidocaine may be considered after return of spontaneous circulation (ROSC) from cardiac arrest due to ventricular fibrillation or pulseless ventricular tachycardia. If a maintenance lidocaine infusion is warranted for an individual patient, administer 1 to 4 mg/minute (30 to 50 mcg/kg/minute) IV. Use lower infusion rates for patients who are elderly, have heart failure or hepatic disease, or are debilitated. Lidocaine is considered an alternative antiarrhythmic to amiodarone for this indication, particularly when amiodarone is not available. Lidocaine is convenient to administer but is not as effective as amiodarone for improving ROSC or survival to hospital admission among adult patients with VF refractory to a shock and epinephrine. Neither drug has been shown to improve survival to hospital discharge in cardiac arrest patients with VF.

Sepsis is caused by a combination of factors related to the particular invading pathogen(s) and to the status of the immune system of the host. [34] The early phase of sepsis characterized by excessive inflammation (sometimes resulting in a cytokine storm ) may be followed by a prolonged period of decreased functioning of the immune system . [35] Either of these phases may prove fatal. On the other hand, systemic inflammatory response syndrome (SIRS) occurs in people without the presence of infection, for example, in those with burns , polytrauma , or the initial state in pancreatitis and chemical pneumonitis . However, sepsis also causes similar response to SIRS. [13]

High dose steroids sepsis

high dose steroids sepsis

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