在儿科重症监护病房使用葡萄糖皮质类药物后的上腺功能衰竭
Ashley N Radig1, Vanessa A Curtis1, Erik Westlund2
1Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
Journal of intensive care medicine
|June 26, 2025
概括
接受葡萄糖皮质醇治疗的儿童重症幸存者患上上腺功能不全的风险为2.3%. 年龄较小,住院时间较长,葡萄糖皮质激素剂量较高与这种情况有关,需要进一步研究.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 内分泌学 在内分泌学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 葡萄糖皮质类药物经常给重症儿童使用.
- 在儿科重症监护室 (PICU) 使用葡萄糖皮质类药物可能会导致随后的上腺功能衰竭.
- 上腺功能不充分导致了儿科重症的幸存者患病率.
研究的目的:
- 为了确定在PICU入院期间暴露于葡萄糖皮质类药物的儿童中上腺功能衰竭的患病率.
- 为了确定与此种人群中上腺功能不全的发展相关的风险因素.
主要方法:
- 追溯性队列研究,涉及结构化医疗记录审查.
- 包括在两年内被录取到学术三级转诊PICU的儿科患者 (0-18岁),接受过葡萄糖皮质体剂.
- 临床特征分析和上腺功能不全的诊断.
主要成果:
- 在接受葡萄糖皮质类药物治疗的530名患者中,2.3%的人被诊断出上腺功能不全.
- 患上上腺功能不全的患者年轻,在PICU和医院住院时间较长,以及1年生存率较低.
- 较高的葡萄糖皮质激素剂量和用于高炎症与上腺功能不充分有关,而类固醇缩小更频繁.
结论:
- 在PICU中接受葡萄糖皮质类药物治疗的儿科患者中,显著的百分比会发展为上腺功能不全.
- 确定了葡萄糖皮质激素后上腺功能不全的潜在风险因素.
- 需要进一步的研究,以了解和减轻上腺功能衰竭对重症儿童结果的影响.
相关概念视频
01:27Adrenal Gland Disorders
1.9K
Adrenal gland disorders manifest when the production of adrenal hormones deviates from the norm, resulting in either excessive or insufficient concentrations.
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
1.9K
01:25Antiasthma Drugs: Inhaled Corticosteroids and Glucocorticoids
399
Inhaled corticosteroids (ICS) are anti-inflammatory drugs used primarily in treating persistent asthma and providing long-term maintenance. They target the bronchial mucosa, the lining of the airways, to control inflammation, a critical factor in asthma progression and exacerbation.
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
399
01:15Hypoglycemia and Glucagon
351
Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
351
01:16Insulin: Dosing Regimen and Adverse Effects
270
Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
270
01:29Acute Kidney Injury III: Clinical Manifestations
105
Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
105
01:22Acute Kidney Injury I: Introduction
83
Introduction:Acute Kidney Injury (AKI) describes a swift decrease in kidney function occurring over hours to days, characterized by the kidneys' failure to remove waste products from the bloodstream. This leads to dangerous complications like metabolic acidosis, fluid overload, and electrolyte imbalances, such as hyperkalemia, which can cause life-threatening arrhythmias. AKI is common in both hospital and outpatient settings, often triggered by dehydration, sepsis, or exposure to nephrotoxic...
83