Hydrocortisone for Multiple Trauma Patients: How Does it Work & What are its Side Effects

What is Hydrocortisone?

Hydrocortisone is a prescription medicine that is available in many forms, including injection and an oral tablet.1 Hydrocortisone belongs to a class of drugs known as adrenocorticosteroids or glucocorticosteroids. A class of drugs refers to a group of medications that work in a similar way and are used for treating similar medical conditions.

Hydrocortisone is used for the treatment of adrenocortical deficiency, for slowing down your immune system, and to reduce swelling and inflammation. The use of hydrocortisone is also approved for the following:2

  • Adrenocortical deficiency3
  • Rheumatic disorders including ankylosing spondylitis and rheumatoid arthritis4
  • Stomach and intestinal diseases including intestinal swelling and ulcerative colitis5
  • Endocrine disorders such as thyroid inflammation 6
  • Eye conditions such as inflammation and severe allergic conditions
  • Collagen disorders such as systemic lupus erythematosus
  • Respiratory conditions such as inflammation of the lung due to aspiration or beryllium or Loeffler’s syndrome7
  • Infections such as meningitis in tuberculosis, tuberculosis, and even roundworm infections8

Hydrocortisone is also used to treat inflammation and swelling caused by the following:

  • Fluid retention or edema
  • Cancer- related conditions such as red blood cell anemia, congenital hypoplastic anemia, idiopathic thrombocytopenic purpura and secondary thrombocytopenia in adults, and autoimmune hemolytic anemia.
  • Skin disorders such as Stevens-Johnson syndrome, mycosis fungoides, seborrheic dermatitis, severe psoriasis, exfoliative dermatitis, and pemphigus – hydrocortisone is used for slowing down the immune system, known as immunosuppression.
  • Allergies – hydrocortisone is used in the treatment of severe conditions when other treatments have failed to work. These include bronchial asthma, allergic rhinitis, skin reactions, serum sickness, and allergic reactions to medications.

Hydrocortisone for Trauma Patients

High doses of corticosteroids, such as hydrocortisone, are being administered to trauma patients to reduce the symptoms of acute stress and post-traumatic stress. Several animal studies have shown that administering high-dose hydrocortisone within the first few hours after a patient undergoes a traumatic experience has been associated with dramatically positive changes in the patient’s exposure to trauma.9

This was observed by a significant reduction in the risk of developing post-traumatic stress disorder post-trauma. The early administration of single high-dose hydrocortisone has been found to reduce the primary symptoms of acute stress and subsequent PTSD in trauma patients.10

Other studies have also found that patients admitted in a hospital with major trauma who were treated with steroid hydrocortisone were significantly less likely to be diagnosed with hospital-acquired pneumonia.11

Severe trauma is known to be a leading cause of death and illness around the world.12 Furthermore, hospital-acquired pneumonia or nosocomial pneumonia is the second most common nosocomial infection acquired in hospitals and accounts for nearly 20 percent of the total.13 It is also the most common cause of death in intensive care units (ICU) and amongst nosocomial infections.14

The overall rate of post-traumatic pneumonia has reached an incidence of 50 to 60 percent, and it has been primarily observed in patients with traumatic brain injury. Early post-traumatic pneumonia is known to increase the duration of hospitalization, mechanical ventilation, and the risk of death. This is why the prevention of post-trauma pneumonia is a major medical issue. So when the administration of hydrocortisone decreases the occurrence and severity of hospital-acquired pneumonia in patients with trauma, this is expected to lead to several potential benefits.

However, a larger study is still needed to define the exact effects of the use of hydrocortisone.15

How Does Hydrocortisone Work?

As mentioned above, hydrocortisone belongs to a class of drugs known as adrenocorticosteroids or glucocorticosteroids. Hydrocortisone is a type of steroid hormone that blocks the functioning of certain proteins in the body. Hydrocortisone decreases swelling and stops the immune system from reacting sharply to different triggers.

Hydrocortisone also affects the manner in which the body stores and uses proteins, carbohydrates, and fats, as well as how the body balances water and electrolytes.16

Side Effects of Hydrocortisone

While hydrocortisone is known to benefit multiple trauma patients, it is not without side effects. Some of the common side effects of hydrocortisone include:

  • Muscle weakness
  • Headaches
  • Skin problems such as shiny skin, acne, or thinning of the skin

Nevertheless, these effects are usually mild and tend to go away on their own within a couple of days or weeks. However, if they are more severe or do not go away after 10 to 15 days, you should consult your doctor.

Call your doctor right away if you experience any serious side effects such as:

  • Allergic reactions such as itching, skin rash, hives, swelling of the lips, face, or tongue, and breathing problems
  • Infections – symptoms may include fever, sore throat, cough, sneezing, and wounds that refuse to heal.
  • High blood sugar
  • Pain in the back, hips, arms, shoulders, ribs, or legs
  • Feeling unusually tired or weak
  • Swelling of the lower legs or feet
  • Seizures

There is still a need for more research to understand how hydrocortisone can help in the treatment of multiple trauma patients. Nevertheless, the initial research is promising and shows that administration of hydrocortisone to trauma patients may help reduce the development of post-traumatic stress and symptoms of acute stress.

References:

  1. Silber, R.H., Busch, R.D. and Oslapas, R., 1958. Practical procedure for estimation of corticosterone or hydrocortisone. Clinical Chemistry, 4(4), pp.278-285.
  2. Derendorf, H., Möllmann, H., Barth, J., Möllmann, C., Tunn, S. and Krieg, M., 1991. Pharmacokinetics and oral bioavailability of hydrocortisone. The Journal of Clinical Pharmacology, 31(5), pp.473-476.
  3. Hart, F.D., 1957. Treatment of adrenocortical deficiency states. British Medical Journal, 1(5016), p.417.
  4. Brown, E.M., Frain, J.B., Udell, L. and Hollander, J.L., 1953. Locally administered hydrocortisone in the rheumatic diseases: a summary of its use in 547 patients. The American journal of medicine, 15(5), pp.656-665.
  5. Truelove, S.C., 1956. Treatment of ulcerative colitis with local hydrocortisone. British Medical Journal, 2(5004), p.1267.
  6. O’Connor, P. and Feely, J., 1987. Clinical pharmacokinetics and endocrine disorders. Clinical pharmacokinetics, 13(6), pp.345-364.
  7. Halliday, G.M. and Salaman, M.R., 1983. The effect of hydrocortisone on PWM and LPS-induced immunoglobulin production in blood leucocytes from patients with systemic lupus erythematosus. Journal of clinical & laboratory immunology, 12(3), pp.141-145.
  8. Favez, G., Aguet, F., Sourdat, P., Magnenat, P. and Brinsmade, A., 1957. The treatment of certain forms of tuberculosis with a combination of prednisone (or hydrocortisone) and antibiotics. Diseases of the Chest, 32(1), pp.70-82.
  9. Zohar, J., Yahalom, H., Kozlovsky, N., Cwikel-Hamzany, S., Matar, M.A., Kaplan, Z., Yehuda, R. and Cohen, H., 2011. High dose hydrocortisone immediately after trauma may alter the trajectory of PTSD: interplay between clinical and animal studies. European Neuropsychopharmacology, 21(11), pp.796-809.
  10. Zohar, J., Yahalom, H., Kozlovsky, N., Cwikel-Hamzany, S., Matar, M.A., Kaplan, Z., Yehuda, R. and Cohen, H., 2011. High dose hydrocortisone immediately after trauma may alter the trajectory of PTSD: interplay between clinical and animal studies. European Neuropsychopharmacology, 21(11), pp.796-809.
  11. Roquilly, A., Mahe, P.J., Seguin, P., Guitton, C., Floch, H., Tellier, A.C., Merson, L., Renard, B., Malledant, Y., Flet, L. and Sebille, V., 2011. Hydrocortisone therapy for patients with multiple trauma: the randomized controlled HYPOLYTE study. Jama, 305(12), pp.1201-1209.
  12. Zatzick, D., Jurkovich, G.J., Rivara, F.P., Wang, J., Fan, M.Y., Joesch, J. and Mackenzie, E., 2008. A national US study of posttraumatic stress disorder, depression, and work and functional outcomes after hospitalization for traumatic injury. Annals of surgery, 248(3), pp.429-437.
  13. Mandell’s Principles and Practices of Infection Diseases 6th Edition (2004) by Gerald L. Mandell MD, MACP, John E. Bennett MD, Raphael Dolin MD, ISBN 0-443-06643-4 • Hardback • 4016 Pages Churchill Livingstone
  14. Harrison’s Principles of Internal Medicine Archived 2012-08-04 at the Wayback Machine 16th Edition, The McGraw-Hill Companies, ISBN 0-07-140235-7
  15. Confalonieri, M., Urbino, R., Potena, A., Piattella, M., Parigi, P., Puccio, G., Della Porta, R., Giorgio, C., Blasi, F., Umberger, R. and Meduri, G.U., 2005. Hydrocortisone infusion for severe community-acquired pneumonia: a preliminary randomized study. American journal of respiratory and critical care medicine, 171(3), pp.242-248.
  16. Garrod, O., 1958. The pharmacology of cortisone, cortisol (hydrocortisone) and their new analogues. Postgraduate medical journal, 34(392), p.300.

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