Aldosterone escape is the phenomenon where, despite persistently elevated aldosterone levels (endogenous or exogenous), the body prevents unchecked sodium retention and volume overload. After an initial period of sodium retention, renal compensatory mechanisms “escape” from aldosterone’s effects. This is clinically relevant in conditions like primary hyperaldosteronism (Conn’s syndrome), patients on chronic…
Desmopressin (DDAVP, antidiuretic hormone) is a synthetic analog of vasopressin that can be administered IV, IM, subQ, and orally. Compared to vasopressin (generally regarded as a potent vasoconstrictor), DDAVP has less efficacy as a pressor, a longer duration, and is a much more potent antidiuretic (hence its use for bedwetting)…
Sandostatin (octreotide) is a subcutaneous, intramuscular, or intravenous analog to somatostatin – a protein hormone secreted throughout the GI tract – which acts via G-protein coupled receptors to inhibit a myriad of other hormones. For example, in the central nervous system, it suppresses the release of prolactin, thyroid stimulating hormone,…
50% dextrose solution (D50W) typically comes as a 50 cc pre-filled syringe containing 25 grams of dextrose. As a cardiac anesthesiologist and intensivist, I most commonly administer D50W to treat profound hypoglycemia or in conjunction with insulin to induce an intracellular shift of potassium in patients with hyperkalemia. Fortunately, these…
Hydrocortisone (Solu-Cortef) is a pharmacologic analog of the steroid hormone cortisol (identical structure) that serves as a reference to gauge the relative mineralcorticoid and glucocorticoid potencies of other steroids. This is similar to how morphine equivalents are used to gauge the analgesic potencies of other opioids.
Stress dose steroids are used in numerous scenarios including adrenal insufficiency, critical care, and the perioperative period. What’s important to understand is that the peak physiologic production of steroid (cortisol) is roughly the equivalent of 300 mg of hydrocortisone a day under maximum stress. Any exogenous steroids which exceed this dose are…
