By: Roxanna Khorzad, DVM, DACVECC, CCRT
Stress response is mediated by the hypothalamic-pituitary-adrenal (HPA) axis and the sympathoadrenal system. Steroid production is a critical component of dealing with stress and blood pressure control.
Relative adrenal insufficiency, sometimes known as critical illness-related corticosteroid insufficiency (CIRCI) has been seen in critically ill patients such as septic shock, hemorrhage, trauma, severe pancreatitis or other systemic illnesses. Intravenous hydrocortisone should be considered to patients when blood pressure is not responsive to fluid resuscitation and vasopressor therapy. Hydrocortisone is the preferred medication and should be used over dexamethasone as dexamethasone can lead to immediate and prolonged suppression of HPA.