Cardiovascular instability following bolus dose of etomidate

A patient with alveolar proteinosis developed unexpected cardiovascular instability after broncho-alveolar lavage. He had received two bolus doses of etomidate within an 18-hour period. Serum cortisol concentrations were low and hydrocortisone replacement therapy was necessary to restore arterial pressure. Implications for management of critically ill patients who receive bolus doses of etomidate are discussed.