One single dose of etomidate negatively influences adrenocortical performance for at least 24h in children with meningococcal sepsis.
OBJECTIVE
To investigate the effect of one single bolus of etomidate used for intubation on adrenal function in children with meningococcal sepsis.


METHODS
Retrospective study conducted between 1997 and 2004.


METHODS
University-affiliated paediatric intensive care unit (PICU).


METHODS
Sixty children admitted to the PICU with meningococcal sepsis, not treated with steroids.


METHODS
Adrenal hormone concentrations were determined as soon as possible after PICU admission, and after 12h and 24h. To assess disease severity, PRISM score and selected laboratory parameters were determined.


RESULTS
On admission, before blood was drawn, 23 children had been intubated with etomidate, 8 without etomidate and 29 were not intubated. Children who were intubated had significantly higher disease severity parameters than those not intubated, whereas none of these parameters significantly differed between children intubated with or without etomidate. Children who received etomidate had significantly lower cortisol, higher ACTH and higher 11-deoxycortisol levels than those who did not receive etomidate. Arterial glucose levels were significantly lower in children who were intubated with etomidate than in non-intubated children. When children were intubated with etomidate, cortisol levels were 3.2 times lower for comparable 11-deoxycortisol levels. Eight children died, seven of whom had received etomidate. Within 24h cortisol/ACTH and cortisol/11-deoxycortisol ratios increased significantly in children who received etomidate, but not in children who did not, resulting in comparable cortisol/ACTH ratios with still significantly lowered cortisol/11-deoxycortisol ratios 24h after admission.


CONCLUSIONS
Our data imply that even one single bolus of etomidate negatively influences adrenal function for at least 24h. It might therefore increase risk of death.
den Brinker
Marieke
M
Department of Pediatrics, Division of Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands.
Hokken-Koelega
Anita C S
AC
Hazelzet
Jan A
JA
de Jong
Frank H
FH
Hop
Wim C J
WC
Joosten
Koen F M
KF
D000305:Adrenal Cortex Hormones / Q000378:metabolism; D000311:Adrenal Glands / Q000187:drug effects* / Q000503:physiopathology; D000309:Adrenal Insufficiency; D002648:Child; D002675:Child, Preschool; D005045:Etomidate / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D008589:Meningococcal Infections / Q000188:drug therapy*; D012189:Retrospective Studies
D000305:Adrenal Cortex Hormones; D006993:Hypnotics and Sedatives; D005045:Etomidate
Crit Care Med. 2000 Jan;28(1):232-5
10667529
J Clin Endocrinol Metab. 2000 Oct;85(10):3746-53
11061534
Pediatr Infect Dis J. 2002 Apr;21(4):330-6
12075765
Crit Care Med. 2003 Jun;31(6):1839-47
12794428
Emerg Med J. 2004 Nov;21(6):655-9
15496686
N Engl J Med. 1984 May 31;310(22):1415-21
6325910
J Clin Endocrinol Metab. 1984 Dec;59(6):1143-7
6092411
Anaesthesia. 1984 Oct;39(10):973-81
6496912
J Pharmacol Exp Ther. 1987 Jan;240(1):259-64
3027305
Crit Care Med. 1988 Nov;16(11):1110-6
3048900
J Clin Endocrinol Metab. 1990 May;70(5):1426-30
2159485
Steroids. 1993 Feb;58(2):64-8
8387232
Circulation. 1995 Oct 15;92(8):2226-35
7554206
N Engl J Med. 1997 Oct 30;337(18):1285-92
9345079
Anaesthesia. 1999 Sep;54(9):861-7
10460557
Intensive Care Med. 2005 Mar;31(3):388-92
15703896
Intensive Care Med. 2005 Mar;31(3):325-6
15750800
Chest. 2005 Mar;127(3):1031-8
15764790
J Clin Endocrinol Metab. 2005 Sep;90(9):5110-7
15985474