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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Med+Case+Rep
2017 ; 11
(1
): 320
Nephropedia Template TP
gab.com Text
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Twit Text #
English Wikipedia
Combined use of high doses of vasopressin and corticosteroids in a patient with
Crohn s disease with refractory septic shock after intestinal perforation: a case
report
#MMPMID29129185
Notaro S
; Sorrentino M
; Ruocco A
; Notaro A
; Corcione A
; Murino P
; Piscitelli E
; Tamborino M
J Med Case Rep
2017[Nov]; 11
(1
): 320
PMID29129185
show ga
BACKGROUND: In this article, we present a clinical case of refractory septic
shock resulting from intestinal perforation treated with high doses of
vasopressin and hydrocortisone during emergency surgery. The use of such high
doses of vasopressin for this type of shock is not described in the literature.
CASE PRESENTATION: A 49-year-old white woman with grade III obesity, Crohn's
disease, and an intestinal perforation presented with refractory septic shock.
Initially, a low dose of vasopressin was used. Then, the dosage was increased to
0.4 U/minute; in the literature, this is defined as "salvage therapy." This
therapy consists of an initial load followed by a continuous infusion of
hydrocortisone. CONCLUSIONS: The significant increase in her cardiac index and
stroke volume index resulted in an improvement in peripheral resistance, gas
exchange, and urine output and a decrease in her heart rate, interleukin-6 level,
and tumor necrosis factor-? level. The administration of high doses of
vasopressin and corticosteroids was demonstrated to be safe for the immune
system, to reduce the systemic inflammatory response, and to have direct
cardiovascular effects. Further studies are required to examine the use of
vasopressin as an initial vasopressor as well as its use in high dosages and in
combination with corticosteroids.