CORTISOL - The Perfect Fish Food

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ofonorow
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Re: CORTISOL - The Perfect Fish Food

Post Number:#16  Post by ofonorow » Sun May 27, 2018 12:34 pm

More fodder - for my surgeon/anesthesiologist. Please note johnwen Jefferies recommendation HUNDREDS of milligrams cortisl/hydrocortison (in the adernally insufficient) when there is an acute overwhelming infection.


GENERALLY ACCEPTED USES OF PHYSIOLOIC DOSAGES

When a patient with adrenal insufficiency encounters stress, additional cortisol is necessary to maintain normal health and sense f well-being. The can vary from the extra 10 mg that may be taken by the businessman who has an unusually strenuous day ahead to the several hundred milligrams per day that may be required in the presence of an acute overwhelming infection. When a patient needs additional steroid, he or she first notices a sensation of fatigue that will disappear as soon as sufficient cortisol is taken. If supplementary glucocorticoid is not taken by patients with more severe degrees of adrenal deficiency, the fatigue may progress to malaise and generalize aching similar to that experienced when a person is developing influenza. If additional steroid is still not taken, nausea, vomiting and collapse with a high fever, fall in blood pressure and shock may ensue.

(Jefferies, Safe Uses of Cortisol, pg 43)




POSTOPERATIVE STATES

Another possible use of physiologic dosages of glucorticoid is in certain postoperative states. When patients with adrenal insufficiency come to surgery, they are routinely given 100 mg of hydrocortisone sodium succinate (Solu-Coref) intramuscularly one hour before surgery is begun: depending on the illness of the patient and the extent of the surgical procedure, post operatively they may receive 100 mg I. M. every eight hours for the first twenty-found hours, gradually tapering over the next week to their maintenance dose, or lower amounts down to 50 mg eight hours after surgery followed by a resumption of usual maintenance dosage by mouth. Such patients have remarkably smooth post operative course, requiring little morphine or other pain-relieving medications, with restoration of strength, ambulation, and a good dietary intake sooner than many patients with normal adrenal function under going similar surgical procedures.

Concerns regarding steroid administration in postoperative states, or course, are the possibility of interference with wound healing, or possible masking of postoperative complications. During the past 44 years (circa 2004), we have had sufficient experience with patients with adrenal insufficiency undergoing surgical procedures to indicate that the dosages of cortisol in the physiological range that has been recommended will not cause any harmful effects. Wounds heal normally, and there is no indication of increased bacterial infection. None of these patients who had previously been taking glucoc\rticoids and hence were given supplementary Solu-Cortef at the time of surgery indicates that such dosages do not mask surgical complications.

(Jefferies, Safe Uses of Cortisol, pg 172-173)



GENERALLY ACCEPTED USES OF PHYSIOLOIC DOSAGES

If the patient is unable to take oral nourishment, supplementary potassium should be given parenterally after the first liter of IV fluid to prevent hypokalemia. This can be satisfactorily achieved by adding 15 mEq potassium chloride to each liter of intravenous fluid after the first until the patient is to take oral nourishment containing potassium such as broth or orange juice. The sodium retaining effect of these dosages of cortisol is sufficient so that supplementary sodium-retaining steroid has not been necessary.

(Jefferies, Safe Uses of Cortisol, pg 44)
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Johnwen
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Re: CORTISOL - The Perfect Fish Food

Post Number:#17  Post by Johnwen » Mon May 28, 2018 10:22 am

You seem to have missed the most important part of this chapter!

Which is!!

After the patient feels well, the dosage of cortisol may usually be
Rapidly tapered to a maintenance level depending upon the nature of the
Stress causing the acute deficiency If the dosage is not tapered sufficiently
promptly, the patient may develop a transient psychosis of a "toxic" type

or hypokalemia sufficient to cause arrhythmia or weakness. The latter
may be mistaken for evidence of an inadequate amount of glucocorticoid,
And if more is given, the patient's condition will ,worsen instead of
improve.
If this is any question, a serum potassium level or an electrocardiogram which will show characteristic changes with hypokalemia,
should be obtained. As soon as the patient feels well, therefore ,it is
Advisable to taper the dosage of cortisol to a maintenance level as quickly
As possible.
This can usually be achieved by decreasing The daily dosage by 20 mg until a satisfactory maintenance level is reached.


https://en.wikipedia.org/wiki/Substance ... _psychosis

https://www.uspharmacist.com/article/sy ... se-effects

https://www.mdedge.com/sites/default/fi ... ticle3.pdf
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Re: CORTISOL - The Perfect Fish Food

Post Number:#18  Post by ofonorow » Wed May 30, 2018 1:57 pm

Yes, noticed and appreciated the word "transient." But in my case I had two raging uncontrollable infections, one of which one was resolved yesterday, and soon the dental infections will be resolved. And I think the "important" point was that 100s of mg of H. C. are required, or at least not unusual.

For the record, I was taking 100 mg orally going in to the surgery. took 50 mg the morning of surgery. They gave me 100 mg Cortef push one hour before surgery (and I was told that they gave me another 100 mg push during the long surgery). I was on 100 iv push every 8 hours yesterday, the first day after surgery, and today I am on 50 mg oral HC every 8 hours. Feel great.
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Re: CORTISOL - The Perfect Fish Food

Post Number:#19  Post by Johnwen » Wed May 30, 2018 4:52 pm

So I’m Guessing they removed the mesh?? If so, “YEA!!!”
The best part is you survived, so not to ask to many questions but did they replace it or just do some debridement and an antiseptic lavage and close???

On the cortisol. since it was hard to follow what you have determined is you normal intake. I would say in about a day or so to try and get back to what you would normally take starting with lowering your night time dose first to about 15mg. Then work on the afternoon dose at this point shoot for 20mg. Then cut the am to about 40 mg. and when you get your mouth fixed try for 30-15-15. If that don’t work for you it would be best to raise the AM dose.

Other then that hope all stays the course and your back on your feet soon. :D

Two more days and all I’ll have to do is my wife’s, “Honey DO” list! :D :D
It’s 2 pages long, NOW! :shock:
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Re: CORTISOL - The Perfect Fish Food

Post Number:#20  Post by ofonorow » Thu May 31, 2018 9:24 am

Large mesh is gone!! They were forced to leave a small "biological mesh" that is supposed to dissolve. (One area too weak for ordinary repair.) Wound vac soon. Wound is open - a new experience.

I still have the dental infection, and they are giving me a type of penicillin that is making the pain in my mouth increasingly worse. (At home I had used colloidal silver to keep mouth pain in check. Surgeon not fond of the vancomycin, antibiotic that seems to control raging dental infection.) Unsure whether to wait for biological mesh to dissolve before having all the abscesses under my dissolving teeth repaired? I think I'll probably wait since the C. silver seems to work.)

So don't expect to get back to completely normal until the dental work is done, but the worst is over!
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