Drugs

Steroids were previously widely used in the critically ill. Their use should be limited to where benefit is likely, and the dose should be reduced if possible.

The internal milieu of the critically ill patient is dominated by the so-called counter-regulatory hormones glucagon, cortisol, and epinephrine (adrenaline). Administration of catecholamines exacerbates this effect and should be reduced if possible. This will obviously depend on improvement in the underlying pathophysiolgy.

Furosemide (frusemide) and thiazides have the potential to exacerbate hyperglycemia.

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