To the Editor.—
I fear that Fine in his Letter (218:741, 1971) has misunderstood the comments in my LETTER (217:697, 1971). I advocated the use of large doses of hydrocortisone primarily because it reverses the disturbed physiological condition that exists in patients with endotoxin shock, including, as he so correctly points out, the restoration of normal permeability of the gut wall. Seven reasons are listed by Hodes1 for using massive doses of hydrocortisone in shock. As an eighth reason, I suggested the possibility of the loss of hydrocortisone as a result of degradation by bacteria in vivo, probably within the circulatory system.The thesis that all types of shock eventually become endotoxin shock if they persist long enough was first developed by Fine2 several years ago. I was not referring, however, to the secondary type in which the shock is primarily traumatic or hypovolemic. In these cases,
Sonnenschein H. Shock and Steroids. JAMA. 1972;219(1):86–87. doi:10.1001/jama.1972.03190270056019
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