title: Salivary cortisol estimation to assess adrenal status in children with fluid unresponsive septic shock.
abstract: We evaluated the adrenal status by estimating baseline and ACTH stimulated salivary cortisol in 51 children with fluid unresponsive septic shock at 30 and 60 minutes, and basal salivary cortisol (9-11 am) in 79 healthy children. The baseline salivary cortisol (median,IQR) among patients (19.8, 7.2-42.4 nmol/L) was higher than healthy children (2.6, 1.3-7.6 nmol/L) (P=0.001). Non-survivors and those with catecholamine refractory shock had higher baseline cortisol level, though difference was statistically insignificant. Absolute adrenal insufficiency (baseline salivary cortisol <1.3nmol/L) was diagnosed in 8 (15.7%) patients. Relative adrenal insufficiency (rise in cortisol level above baseline value after stimulation <25nmol/L) was observed in 68.6% of all patients; 71.9% among non-survivors, and in 71.4% patients with catecholamine refractory shock. Salivary cortisol estimation appears to be feasible in children with septic shock. Relative adrenal insufficiency is common in these children.
authors.affiliation: Department of Pediatrics, Chhatrapati Shahuji Maharaj Medical University, Lucknow 226 003, Uttar Pradesh, India. drsn.singh@rediffmail.com
authors.forename: S N
authors.initials: SN
authors.lastname: Singh
authors.forename: S K
authors.initials: SK
authors.lastname: Rathia
authors.forename: Shally
authors.initials: S
authors.lastname: Awasthi
authors.forename: Anita
authors.initials: A
authors.lastname: Singh
authors.forename: Vijaylaxmi
authors.initials: V
authors.lastname: Bhatia
mesh_terms: D000309:Adrenal Insufficiency / Q000175:diagnosis* / Q000378:metabolism; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007223:Infant; D008297:Male; D012463:Saliva / Q000378:metabolism*; D012772:Shock, Septic / Q000378:metabolism* / Q000628:therapy
chemical_list: D006854:Hydrocortisone