title: Arterial bicarbonate may be a useful indicator of inadequate cortisol response in children with catecholamine resistant septic shock.
abstract: OBJECTIVE
  To study the clinical and biochemical parameters that can predict cortisol insufficiency in children with septic shock.
  
  
  METHODS
  prospective, observational study.
  
  
  METHODS
  Tertiary health-care center.
  
  
  METHODS
  Fifty children admitted with the catecholamine resistant septic shock to a tertiary health-care center.
  
  
  METHODS
  At the time of hospitalization all patients underwent detailed clinical evaluation including, history and physical examination, evaluation with the complete blood count, serum cortisol, renal function tests, liver function tests, prothrombin time activated partial thromboplastin time, arterial blood gas analysis, urine analysis, chest roentgenogram, ultrasonography of the abdomen and chest, urine, and blood culture for bacteria and fungi.
  
  
  RESULTS
  Out of 50 children with the catecholamine resistant septic shock, seven had adrenal insufficiency (serum cortisol <18 μg/dl). Of all parameters studied, only arterial bicarbonate at the time of admission to intensive care predicted adrenal insufficiency. On Receptor operative characteristic curve analysis, a bicarbonate level of 10.9 mEq/L had the best accuracy to predict adrenal insufficiency.
  
  
  CONCLUSIONS
  Arterial bicarbonate may be used as a rapid test for provisional identification of adrenal insufficiency among children with the catecholamine resistant septic shock.
authors.affiliation: Department of Pediatrics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India.
authors.forename: M B
authors.initials: MB
authors.lastname: Maralihalli
authors.forename: C T
authors.initials: CT
authors.lastname: Deshmukh
mesh_terms: D000293:Adolescent; D000309:Adrenal Insufficiency / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D001639:Bicarbonates / Q000097:blood*; D002395:Catecholamines; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood* / Q000627:therapeutic use; D008297:Male; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012772:Shock, Septic / Q000097:blood* / Q000150:complications / Q000503:physiopathology
chemical_list: D001639:Bicarbonates; D002395:Catecholamines; D006854:Hydrocortisone