Using a Short ACTH Stimulation Test to Identify Patients with Septic Shock Who Have Relative Adrenocortical Insufficiency

Purpose: To evaluate a patient with septic shock for relative adrenocortical insufficiency using a short ACTH stimulationt test.

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Evaluation

Are you evaluating a patient with septic shock?

Yes

Number of hours between diagnosis of severe sepsis and performance of the short ACTH stimulation test

Baseline serum cortisol level

Serum cortisol level at 30 minutes after administering ACTH 250 µg IV

Serum cortisol level at 60 minutes after administering ACTH 250 µg IV

Results

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Results Interpretation and Description References Next Steps

Data complete?

Evaluation appropriate?

Peak cortisol response

Rise in cortisol from baseline to peak

Is the patient an inadequate responder based on the criteria of Annane et al?

Is the patient an inadequate responder based on the criteria of Loisa et al?

Is the patient likely to benefit from low dose corticosteroid administration?

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Interpretation and Description

References

Next Steps in Evaluation

Diagnosis

Risk Factors
Clinical Diagnosis, Including Family History For Genetics
Laboratory Tests
- Septic Shock Score
- Identification of Patients with the Systemic Inflammatory Response Syndrome (SIRS) After Trauma Who Are Infected
Other Testing
- Quick SOFA (qSOFA) Score
Criteria For Diagnosis
Severity, Prognosis, Stage

Therapy

Selection
- Dopamine-Resistant Septic Shock
Pharmacogenetics
- Dopamine-Resistant Septic Shock
Failure Handling And Therapy Escalation

Monitoring

Disease Progression

Specialty

Critical Care
Emergency Medicine
Infectious Diseases

Objective

risk factors
clinical diagnosis
including family history for genetics
laboratory tests
selection

ICD-10

A49.9 - Bacterial infection, unspecified
R57.2 - Septic shock

Info

Purpose: To evaluate a patient with septic shock for relative adrenocortical insufficiency using a short ACTH stimulationt test.

Specialty: Critical Care, Emergency Medicine, Infectious Diseases

Objective: risk factors, clinical diagnosis, including family history for genetics, laboratory tests, selection

ICD-10: A49.9, R57.2,

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