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  • Critical illness–related corticosteroid insufficiency (CIRCI) is defined as inadequate corticosteroid activity for the severity of the patient's illness


  • Possible complications from corticosteroid therapy:
    • Immune suppression
    • Increased risk of infections (wound, nosocomial)
    • Impaired wound healing
    • Hyperglycemia
    • Myopathy
    • Psychosis
    • Hypokalemic metabolic acidosis
    • Further HPA and glucocorticoid receptor suppression

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Table 212-1 Etiology, Symptoms, and Diagnosis of Adrenal Insufficiency in Critically Ill Patients
Figure 212-1. Algorithm for the Management of Patient with Suspected Critical Illness–Related Corticosteroid Insufficiency (CIRCI)
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1. Marik P. Critical illness-related corticosteroid insufficiency. Chest. 2009 Jan;135(1):181–193.   [PubMed: 19136406]
2. Marik PE, Pastores SM, Ananne D, et al. Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine. Crit Care Med. 2008 Jun;36(6):1937–1949.   [PubMed: 18496365]
3. Dellinger P, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: international guidelines for the management of severe sepsis and septic shock: 2008. Crit Care Med. 2008 Jan;36:296–327.   [PubMed: 18158437]

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