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Refractory Septic Shock — RACP Adult Medicine MCQ

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ModerateInfectious DiseasesRefractory Septic ShockRACP Adult Medicine

A 50-year-old man with septic shock is on noradrenaline 0.5 μg/kg/min and vasopressin 0.03 U/min. MAP remains 60 mmHg. He has received appropriate antibiotics and 40 mL/kg IV crystalloid. Random cortisol is 350 nmol/L. What is the most appropriate next step?

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Correct answer: B — IV hydrocortisone 200 mg/day

Refractory septic shock (not responding to adequate fluids + two vasopressors) is an indication for IV hydrocortisone (200 mg/day as continuous infusion or 50 mg QID). SSC 2021 suggests hydrocortisone for septic shock with ongoing vasopressor requirement. The ADRENAL and APROCCHSS trials support its use for haemodynamic stabilisation, though mortality benefit is debated.

Reference: Surviving Sepsis Campaign 2021; ADRENAL Trial; eTG Antibiotic 2025