Volume 18 Supplement 1

34th International Symposium on Intensive Care and Emergency Medicine

Open Access

Continuous administration of corticosteroids in septic shock can reduce risk of hypernatremia

  • L Mirea1,
  • R Ungureanu1,
  • D Pavelescu1,
  • IC Grintescu1,
  • C Dumitrache2,
  • I Grintescu1 and
  • D Mirea3
Critical Care201418(Suppl 1):P239

DOI: 10.1186/cc13429

Published: 17 March 2014


Although the administration of hydrocortisone in septic shock generates adverse effects, the risk of corticosteroid-induced hypernatremia may be reduced by continuous administration of the drug [1][2].


A total of 171 patients with septic shock were randomized into three study groups: group A (n = 58), 200 mg/day hydrocortisone hemisuccinate in four doses; group B (n = 59), same dose of hydrocortisone hemisuccinate in continuous administration; group C (n = 54), no hydrocortisone hemisuccinate. Mean serum sodium values, the number of hypernatremia episodes and variations in serum sodium (Na var) were investigated for 7 days. The local ethics committee approved the study.


There were no differences between the three groups at the beginning of the study regarding demographic data and the clinical characteristics. Mean values of natremia were normal in group C (140.35 ± 7.390 mEq/l to 144.79 ± 8.338 mEq/l) during the study period. High mean values appeared on day 4 in group A (147.21 ± 8.470 mEq/l to 149.37 ± 8.973 mEq/l on day 7) and on day 5 in group B (146.36 ± 8.272 mEq/l to 147.70 ± 8.865 mEq/l). Na var was 8.59 ± 5.960 mEq/l (-8 and 21 mEq/l) in group A, 6.63 ± 7.609 mEq/l (-17 and 23 mEq/l) in group B and 4.54 ± 7.455 mEq/l (-12 and 22 mEq/l) in group C. This variation is statistically significant when groups A and B are compared with group C (P = 0.012) and when only group A is compared with group C (P = 0.0019). The risk of hypernatremia after hydrocortisone hemisuccinate was almost three times higher than that of patients who did not receive this drug (RR 2.82, 1.35 <OR <5.90, P = 0.0041) and slightly higher when HHS was delivered as a bolus (RR 3.08, 1.32 <OR <7.25, P = 0.0071).


Continuous administration of hydrocortisone hemi- succinate in septic shock is associated with a lower risk of hypernatremia than bolus administration.

Authors’ Affiliations

Clinical Emergency Hospital of Bucharest
CI Parhon National Institute of Endocrinology
Elias University Emergency Hospital


  1. Sprung CL, Annane D, Keh D, et al.: Hydrocortisone therapy for patients with septic shock. N EnglJ Med 2008, 358: 111-124. 10.1056/NEJMoa071366View ArticleGoogle Scholar
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© Mirea et al.; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.