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Arterial bicarbonate may be a useful indicator of inadequate cortisol response in children with catecholamine

M B Maralihalli1, C T Deshmukh

  • 1Department of Pediatrics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India.

Journal of Postgraduate Medicine
|June 25, 2013
PubMed

Insights

Arterial bicarbonate levels can help quickly identify adrenal insufficiency in children with septic shock. This finding aids in the early provisional diagnosis of cortisol deficiency in critically ill pediatric patients.

Area of Science:

  • Pediatric critical care medicine
  • Pediatric endocrinology
  • Septic shock management

Background:

  • Septic shock in children can lead to cortisol insufficiency, a condition requiring prompt recognition.
  • Identifying predictors of adrenal insufficiency is crucial for timely intervention in pediatric septic shock.

Purpose of the Study:

  • To identify clinical and biochemical parameters that predict cortisol insufficiency in children experiencing septic shock.
  • To evaluate the utility of various laboratory tests in diagnosing adrenal insufficiency in this population.

Main Methods:

  • A prospective, observational study was conducted on 50 children with catecholamine-resistant septic shock.
  • Clinical and biochemical parameters, including arterial blood gas analysis, were assessed upon intensive care unit admission.

Main Results:

  • Seven out of 50 children (14%) exhibited adrenal insufficiency (serum cortisol <18 μg/dl).
  • Arterial bicarbonate levels at admission were the sole significant predictor of adrenal insufficiency.
  • An arterial bicarbonate level of 10.9 mEq/L demonstrated the highest accuracy in predicting adrenal insufficiency.

Conclusions:

  • Arterial bicarbonate serves as a rapid and effective marker for the provisional identification of adrenal insufficiency in children with catecholamine-resistant septic shock.
  • This biochemical parameter can guide early management decisions in critically ill children with suspected cortisol deficiency.
Abstract

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