The “koala stress syndrome” and adrenal responsiveness in the critically ill

Marik, Paul E.; Levitov, Alexander

doi:10.1007/s00134-010-1974-6

Cited by 15 publications

(8 citation statements)

References 14 publications

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“…This suggests that, even in patients with no response to corticotropin, the basal cortisol level may be important in stratifying the risk of mortality and possibly the response to corticosteroid therapy. Some authors have suggested that different subgroups of CIRCI may be useful for predicting the benefits of corticosteroid therapy and that only patients in the LDC group may benefit from corticosteroid therapy (15). Our study results suggest the opposite: Only patients with a low basal cortisol level regardless of $ cortisol may benefit from corticosteroid therapy.…”

Section: Discussioncontrasting

confidence: 45%

Prognostic Significance of Different Subgroup Classifications of Critical Illness-Related Corticosteroid Insufficiency in Patients With Septic Shock

Lim

Kwon

Park

et al. 2011

Shock

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The purpose of this study was to evaluate the prognostic significance of classification of patients with septic shock into different critical illness-related corticosteroid insufficiency subgroups. A retrospective observational study was conducted in patients with septic shock who underwent a short corticotropin stimulation test within 72 h of the onset of shock. Patients were classified into normal adrenal function (NOM), low basal cortisol (LBC) (basal cortisol, <10 μg/dL), or low Δ cortisol (LDC) (basal cortisol, ≥10 μg/dL; cortisol, <9 μg/dL) groups. A total of 168 septic shock patients were recruited. Forty-two patients (25%) were assigned to the NOM group, 39 (23.2%) to the LBC group, and 87 (51.8%) to the LDC group. All of the patients received hydrocortisone therapy. Patients in the LDC group had significantly higher Simplified Acute Physiology Score 3 (P < 0.001) and Sequential Organ Failure Assessment score (P < 0.001) than did patients in the NOM group. The 28-day mortalities of the NOM, LBC, and LDC groups were 40.5%, 38.5%, and 63.2%, respectively (P = 0.007). Classification into the LDC group significantly increased the odds of 28-day mortality (odds ratio, 2.717; 95% confidence interval, 1.452-5.082; P = 0.002) and remained an independent risk factor for mortality even after controlling for all the other potential risk factors identified (odds ratio, 3.638; 95% confidence interval, 1.418-9.028; P = 0.006). Classification into the LDC group is an independent risk factor for mortality in hydrocortisone-treated septic shock patients.

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Section: Discussioncontrasting

confidence: 45%

Prognostic Significance of Different Subgroup Classifications of Critical Illness-Related Corticosteroid Insufficiency in Patients With Septic Shock

Lim

Kwon

Park

et al. 2011

Shock

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“…This koala was clinically normal, and his haematology and biochemistry were unremarkable except that he was hyperglycaemic at the time of sampling (9.2 mmol/L; reference range 3.0–8.5 mmol/L), but his blood glucose concentration was within normal range two weeks after the initial reading. Hyperglycaemia is not uncommon in koalas that have been transported for a procedure which may induce stress (Marik & Levitov, ; Narayan, Webster, Nicolson, Mucci, & Hero, ). It is problematic to explain the reason for the difference in amoxicillin profiles between this koala and the other three.…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetic profile of amoxicillin and its glucuronide‐like metabolite when administered subcutaneously to koalas (Phascolarctos cinereus)

Kimble

Vogelnest

Gharibi

et al. 2019

Vet Pharm & Therapeutics

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Amoxicillin was administered as a single subcutaneous injection at 12.5 mg/kg to four koalas and changes in amoxicillin plasma concentrations over 24 hr were quantified. Amoxicillin had a relatively low average ± SD maximum plasma concentration (Cmax) of 1.72 ± 0.47 µg/ml; at an average ± SD time to reach Cmax (Tmax) of 2.25 ± 1.26 hr, and an elimination half‐life of 4.38 ± 2.40 hr. The pharmacokinetic profile indicated relatively poor subcutaneous absorption. A metabolite was also identified, likely associated with glucuronic acid conjugation. Bacterial growth inhibition assays demonstrated that all plasma samples other than t = 0 hr, inhibited the growth of Escherichia coli ATCC 25922 and Staphylococcus aureus ATCC 29213 to some extent. Calculated pharmacokinetic indices were used to predict whether this dose could attain a plasma concentration to inhibit some susceptible Gram‐negative and Gram‐positive pathogens. It was predicted that a twice daily dose of 12.5 mg/kg would be efficacious to inhibit susceptible bacteria with an amoxicillin minimum inhibitory concentration (MIC) ≤ 0.75 µg/ml such as susceptible Bordetella bronchiseptica, E. coli, Staphylococcus spp. and Streptococcus spp. pathogens.

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“…Hart and colleagues [15] demonstrated that hemorrhage, hypoxia and sepsis were amongst those stressors that resulted in the highest epinephrine and norepinephrine levels. In reviewing the literature, we have demonstrated large interspecies differences in the degree of activation of the HPA axis with stress, with humans having the greatest increase in serum cortisol level (Figure 3) [16]. …”

Section: Acute Illness the Stress Response And Stress Hyperglycemiamentioning

confidence: 99%

Stress hyperglycemia: an essential survival response!

2013

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Stress hyperglycemia is common in critically ill patients and appears to be a marker of disease severity. Furthermore, both the admission as well as the mean glucose level during the hospital stay is strongly associated with patient outcomes. Clinicians, researchers and policy makers have assumed this association to be causal with the widespread adoption of protocols and programs for tight in-hospital glycemic control. However, a critical appraisal of the literature has demonstrated that attempts at tight glycemic control in both ICU and non-ICU patients do not improve health care outcomes. We suggest that hyperglycemia and insulin resistance in the setting of acute illness is an evolutionarily preserved adaptive responsive that increases the host's chances of survival. Furthermore, attempts to interfere with this exceedingly complex multi-system adaptive response may be harmful. This paper reviews the pathophysiology of stress hyperglycemia and insulin resistance and the protective role of stress hyperglycemia during acute illness.

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The “koala stress syndrome” and adrenal responsiveness in the critically ill

Cited by 15 publications

References 14 publications

Prognostic Significance of Different Subgroup Classifications of Critical Illness-Related Corticosteroid Insufficiency in Patients With Septic Shock

Prognostic Significance of Different Subgroup Classifications of Critical Illness-Related Corticosteroid Insufficiency in Patients With Septic Shock

Pharmacokinetic profile of amoxicillin and its glucuronide‐like metabolite when administered subcutaneously to koalas (Phascolarctos cinereus)

Stress hyperglycemia: an essential survival response!

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