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Dexmedetomidine Infusion Associated with Transient Adrenal Insufficiency in a Pediatric Patient: A Case Report

Dexmedetomidine is a highly selective α (2)-adrenoceptor agonist used for sedation due to its anxiolytic and analgesic properties without respiratory compromise. Due to its structural similarity to etomidate, there has been concern that dexmedetomidine may cause adrenal insufficiency. This concern w...

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Autores principales: Tucker, Elizabeth W., Cooke, David W., Kudchadkar, Sapna R., Klaus, Sybil Ann
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi Publishing Corporation 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3670516/
https://www.ncbi.nlm.nih.gov/pubmed/23762715
http://dx.doi.org/10.1155/2013/207907
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author Tucker, Elizabeth W.
Cooke, David W.
Kudchadkar, Sapna R.
Klaus, Sybil Ann
author_facet Tucker, Elizabeth W.
Cooke, David W.
Kudchadkar, Sapna R.
Klaus, Sybil Ann
author_sort Tucker, Elizabeth W.
collection PubMed
description Dexmedetomidine is a highly selective α (2)-adrenoceptor agonist used for sedation due to its anxiolytic and analgesic properties without respiratory compromise. Due to its structural similarity to etomidate, there has been concern that dexmedetomidine may cause adrenal insufficiency. This concern was initially supported by animal studies, but subsequent human studies demonstrated mixed results. We describe the case of transient adrenal insufficiency in a 1-year-old male who presented with 24% total body surface 2nd degree burns. He required sedation with a prolonged, high-dose dexmedetomidine infusion with a peak infusion dose of 2.7 mcg/kg/hr and duration of 6.5 days. The patient developed lethargy and hypotension four days after discontinuation of his infusion. He had a random cortisol level which was low at 0.4 mcg/dL, and the concern for adrenal suppression was confirmed with an ACTH stimulation test with the baseline cortisol of 0.4 mcg/dL and inappropriate 60 minute post-ACTH stimulation cortisol of 7.8 mcg/dL. While further studies will be needed to clarify the risk of adrenal suppression secondary to dexmedetomidine, this case suggests that caution should be taken when administering dexmedetomidine to pediatric patients and highlights the need for future studies to look at appropriate dosing and duration of dexmedetomidine infusions.
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spelling pubmed-36705162013-06-12 Dexmedetomidine Infusion Associated with Transient Adrenal Insufficiency in a Pediatric Patient: A Case Report Tucker, Elizabeth W. Cooke, David W. Kudchadkar, Sapna R. Klaus, Sybil Ann Case Rep Pediatr Case Report Dexmedetomidine is a highly selective α (2)-adrenoceptor agonist used for sedation due to its anxiolytic and analgesic properties without respiratory compromise. Due to its structural similarity to etomidate, there has been concern that dexmedetomidine may cause adrenal insufficiency. This concern was initially supported by animal studies, but subsequent human studies demonstrated mixed results. We describe the case of transient adrenal insufficiency in a 1-year-old male who presented with 24% total body surface 2nd degree burns. He required sedation with a prolonged, high-dose dexmedetomidine infusion with a peak infusion dose of 2.7 mcg/kg/hr and duration of 6.5 days. The patient developed lethargy and hypotension four days after discontinuation of his infusion. He had a random cortisol level which was low at 0.4 mcg/dL, and the concern for adrenal suppression was confirmed with an ACTH stimulation test with the baseline cortisol of 0.4 mcg/dL and inappropriate 60 minute post-ACTH stimulation cortisol of 7.8 mcg/dL. While further studies will be needed to clarify the risk of adrenal suppression secondary to dexmedetomidine, this case suggests that caution should be taken when administering dexmedetomidine to pediatric patients and highlights the need for future studies to look at appropriate dosing and duration of dexmedetomidine infusions. Hindawi Publishing Corporation 2013 2013-05-16 /pmc/articles/PMC3670516/ /pubmed/23762715 http://dx.doi.org/10.1155/2013/207907 Text en Copyright © 2013 Elizabeth W. Tucker et al. https://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Tucker, Elizabeth W.
Cooke, David W.
Kudchadkar, Sapna R.
Klaus, Sybil Ann
Dexmedetomidine Infusion Associated with Transient Adrenal Insufficiency in a Pediatric Patient: A Case Report
title Dexmedetomidine Infusion Associated with Transient Adrenal Insufficiency in a Pediatric Patient: A Case Report
title_full Dexmedetomidine Infusion Associated with Transient Adrenal Insufficiency in a Pediatric Patient: A Case Report
title_fullStr Dexmedetomidine Infusion Associated with Transient Adrenal Insufficiency in a Pediatric Patient: A Case Report
title_full_unstemmed Dexmedetomidine Infusion Associated with Transient Adrenal Insufficiency in a Pediatric Patient: A Case Report
title_short Dexmedetomidine Infusion Associated with Transient Adrenal Insufficiency in a Pediatric Patient: A Case Report
title_sort dexmedetomidine infusion associated with transient adrenal insufficiency in a pediatric patient: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3670516/
https://www.ncbi.nlm.nih.gov/pubmed/23762715
http://dx.doi.org/10.1155/2013/207907
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