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The Physiological Basis for the Use of Pharmacological Doses of Corticosteroids in Bacterial Shock.

Jerrold K. Longerbeam, M.D.; Jack H. Block, M.D.; William A. Manax, M.D.; and Richard C. Lillehei, M.D.
Ann Intern Med. 1964;60(4):712-713. doi:10.7326/0003-4819-60-4-712_3
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Controversy continues over the use of corticosteroids in treating bacterial shock. This is largely due to the failure to appreciate the hemodynamic, chemical, and visceral tissue disturbances that are caused by endotoxins. Equally at fault is the failure to recognize the effect of pharmacological doses of corticosteroids to right such changes. In the dog, endotoxin shock is characterized by a progressive rise in visceral organ, as well as total, peripheral resistance due to arteriolar and venular vasospasm. Accompanying this are striking elevations of plasma catecholamines which intensify the vasospasm. Concomitantly, cardiac output, visceral organ blood flow and blood volume decrease


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