title: The role of ascorbic acid and xylitol in etomidate-induced adrenocortical suppression in humans.
abstract: Etomidate-induced suppression of cortisol biosynthesis is a result of a blockade of 11-beta-hydroxylation in the adrenal gland, mediated by the imidazol radical of etomidate. Since the generation of steroids requires reductive and energy rich equivalents, the present study examined whether supplementation with ascorbic acid or xylitol, a major source of NADPH, could attenuate adrenal suppression by etomidate in human subjects by promoting the turnover rate of 11-beta-hydroxylase. During continuous etomidate/alfentanil anaesthesia for pelviscopic surgery 30 female patients received either Ringer's lactate, xylitol (0.25 g kg-1 h-1) or ascorbic acid (0.5 g h-1) intravenously (i.v.). The plasma concentrations of cortisol, aldosterone and dehydroepiandrosterone (DHEA) were recorded for 5 h after end of surgery and a stimulation with synthetic ACTH was performed. The results showed no evidence of a clinically relevant attenuating effect of ascorbic acid or xylitol on etomidate-induced adrenocortical suppression. However, the observed suppression of cortisol levels was not enough to allow an attenuating affect to be measured.
authors.affiliation: Clinic of Anaesthesiology, University of Ulm Medical School, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Schraag
authors.forename: M
authors.initials: M
authors.lastname: Pawlik
authors.forename: U
authors.initials: U
authors.lastname: Mohl
authors.forename: B O
authors.initials: BO
authors.lastname: Böhm
authors.forename: M
authors.initials: M
authors.lastname: Georgieff
mesh_terms: D000293:Adolescent; D000302:Adrenal Cortex / Q000187:drug effects*; D000309:Adrenal Insufficiency / Q000139:chemically induced / Q000517:prevention & control*; D000324:Adrenocorticotropic Hormone / Q000494:pharmacology; D000328:Adult; D000450:Aldosterone / Q000097:blood; D015760:Alfentanil / Q000008:administration & dosage / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D001205:Ascorbic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D003687:Dehydroepiandrosterone / Q000097:blood; D004724:Endoscopy; D005045:Etomidate / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000037:antagonists & inhibitors / Q000097:blood; D006900:Hydroxylation / Q000187:drug effects; D007275:Injections, Intravenous; D007552:Isotonic Solutions; D008875:Middle Aged; D006899:Mixed Function Oxygenases / Q000187:drug effects; D009249:NADP / Q000627:therapeutic use; D010084:Oxidation-Reduction; D010388:Pelvis; D000077325:Ringer's Lactate; D014993:Xylitol / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D018686:Anesthetics, Intravenous; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D015760:Alfentanil; D003687:Dehydroepiandrosterone; D000450:Aldosterone; D009249:NADP; D000324:Adrenocorticotropic Hormone; D006899:Mixed Function Oxygenases; D001205:Ascorbic Acid; D014993:Xylitol; D006854:Hydrocortisone; D005045:Etomidate