الفهرس 
ADRENAL INSUFFICIENCY IN CRITICALLY ILL PATIENTSOnly 14 pages are availabe for public view
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Abstract
Our work aimed at assing the frequency of adrenal insufficiency and critical illness-related corticosteroid insufficiency (CIRCI) in pediatric acute lung injury/acute respiratory distress syndrome and its clinical outcome.
Patients were collected from Pediatric Intensive Care Unit of Children`s hospital,Ain shams university,over 6 months.They examined clinically through age, sex, degree of ARDS/ALI by Murray Score and manifestation of AI.
Random Cortisol level was done for our cases for diagnosis of adrenal insufficiency in critically ill children.
Our study demonstrated that the prevalence of AI was very high in pediatric ALI/ARDS during the period of the study which is similar to the previously reported.
Our study demonstrated that cases with AI had no hyponatremia or hyperkalemia, which is classically found in an individual with AI.
Traditionally the etiological factors of ARDS are classified as those causing direct injury to the lungs and those that cause injury indirectly in the setting of a systemic process. The common causes associated with direct lung injury are pneumonia and aspiration; near drowning, pulmonary embolism and pulmonary contusion are less common. We observed that direct lung injury was the risk factor in children.
Pneumonia was the most common in our study. Sepsis is the commonest cause of indirect lung injury. Sepsis was very common in childrendeveloping ARDS in our study. Shock followed by sepsis was the most common accompanying feature and was associated with high mortality.
Our study showed that the outcome of cases with ARDS and AI very low and decresed than the past as reported previousely.
In conclusion our study reported that AI may be common among children with ALI/ARDS. The HPA axis appears to be an important component of the stress response and modulates the systemic cardiovascular and cellular response to injury. These results would be an initial step to further study the impact of AI on clinical outcome of children in a large scale.
Critically ill children under stress have lower cortisol and developed some sort of AI.