Septic shock refractory to fluids and vasopressors (especially relative adrenal insufficiency/CIRCI).
โข Noradrenaline infusion โ First-line vasopressor to maintain blood pressure and improve organ perfusion.
โข IV Hydrocortisone โ Added in patients who remain hypotensive despite adequate fluids and vasopressor support, as it helps restore vascular responsiveness to catecholamines.
This combination is classically seen in refractory septic shock in the ICU.
High-yield pearl:
If a patient in septic shock still requires significant doses of noradrenaline to maintain MAP despite adequate resuscitation, think about adding IV hydrocortisone (typically 200 mg/day).
๐ง Edema is not a diagnosis โ itโs a clinical clue.
From heart failure โค๏ธ to kidney disease ๐ฉบ, liver cirrhosis ๐ซ, and hypothyroidism ๐ฆ, understanding why fluid accumulates is the key to finding the cause.
Master the mechanisms.
Recognize the patterns.
Treat the patient, not just the swelling.
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