Strategic administration of an appeasing substance to improve performance and physiological responses of Bos indicus feedlot cattle

2021 ◽  
Author(s):  
Vitor G L Fonseca ◽  
Bruno I Cappellozza ◽  
Osvaldo A de Sousa ◽  
Manuella Sagawa ◽  
Bruna Rett ◽  
...  
Keyword(s):  
Serum Insulin ◽  
Physiological Responses ◽  
Bos Indicus ◽  
Serum Cortisol ◽  
Serum Glucose ◽  
Feedlot Cattle ◽  
Skin Area ◽  
Feeding Period ◽  
Treatment Administration ◽  
To Receive

Abstract This study was designed to evaluate the timing of administration of the bovine appeasing substance (BAS) on performance and physiological responses of Bos indicus feedlot cattle. Nellore bulls (n = 100) were ranked by initial body weight (BW; 341 ± 18.5 kg) and assigned to receive BAS (n = 50) or placebo (CON; n = 50) on d -2 of the experiment. Treatments (5 mL) were applied topically to the nuchal skin area of each bull. Bulls were loaded into commercial livestock trailers immediately after treatment administration, transported for 880 km, and unloaded on d -1 at a commercial feedyard. On d 0, bulls within each treatment were again assigned to receive, in a 2 x 2 factorial arrangement, BAS or CON as previously described (25 bulls/treatment combination). Upon treatment administration on d 0, bulls were housed in 12 feedlot pens (3 pens/treatment) for a 108-d feeding period, which was divided into an adaptation (d 0 – 19), growing (d 20 – 60), and finishing (d 61 – 108) phases. Dry matter intake (DMI) was measured daily from d 0 to 108, whereas blood samples and hair from the tail switch were collected on d -2, 0, 19, 60, and 108. Administration of BAS prior to loading (d -2) improved ADG, FE, and DMI during adaptation and across the 108-d feeding period (P ≤ 0.08), resulting in greater (P = 0.03) hot carcass weight and dressing percentage upon slaughter on d 109. A treatment × day interaction was detected for serum glucose concentrations (P = 0.05), which was greater (P = 0.03) on d 60 of the feeding period in bulls receiving CON prior to loading. Administration of BAS at feedlot entry (d 0) improved DMI, ADG, and FE during adaptation (P ≤ 0.05), but it did not impact (P ≥ 0.18) performance and carcass traits during the 108-d feeding period. Bulls administered BAS prior to loading and at feedlot entry had less (P ≤ 0.05) mean serum cortisol concentrations across the 108-d feeding period (loading × feedlot entry interaction; P = 0.10), and greater (P ≤ 0.05) serum insulin concentration on d 60 (loading × feedlot entry × day interaction; P = 0.05). In summary, BAS administration prior to loading increased overall feedlot performance of Nellore bulls. These outcomes were noted in bulls that received or not a second BAS administration at feedlot entry, suggesting that the benefits of BAS are exploited when this substance is administered before transport to the feedlot.

8 Effects of a Bovine Appeasing Substance Application at Weaning on Temperament and Growth of Bos Indicus Influenced Heifers

2021 ◽  
Vol 99 (Supplement_3) ◽  
pp. 3-4
Author(s):  
Douglas G Viera ◽  
Juliana Ranches ◽  
Marcelo Vedovatto ◽  
Giovana G Pirota ◽  
Bruno I Cappellozza ◽  
...  
Keyword(s):  
Body Weight ◽  
Single Dose ◽  
Beef Cattle ◽  
Average Daily Gain ◽  
Bos Indicus ◽  
Cattle Herd ◽  
Synthetic Analogue ◽  
Skin Area ◽  
To Receive ◽  
Daily Gain

Abstract The objective of this study was to evaluate the effects of a synthetic analogue of the bovine appeasing pheromone (i.e. bovine appeasing substance; BAS) on growth and temperament of heifers. At weaning (d 0), 30 heifers (Aberdeen Angus ′ Nelore; 8 ± 1 mo) were stratified by body weight (199.8 ± 16 kg) and randomly assigned to receive a single dose of BAS (n = 15; SecureCattle; Nutricorp, Araras, SP, Brazil) or saline (CON; n = 15; saline 0.9% NaCl). Treatments (5 ml) were topically applied to the nuchal skin area of each animal on d0. Body weight was collected on d 0, 6, 15, 45, and 150. Chute score (1 to 5; 1 = calm, no movement; 5 = violent and continuous struggling) and chute entrance and exit score (1 to 3; 1 = slow; 3 = fast) were collected on d 0, 2, 6, 15, 45 and 150. Scores were averaged across 4 trained technicians. Data were analyzed using the MIXED procedure of SAS. Heifers assigned to BAS had greater (P < 0.01) average daily gain (ADG) than heifers assigned to CON treatment from d 6 to 15 (2.35 and 1.88 kg/d ± 0.16) and from d 15 to 45 (1.79 vs. 1.56 kg/d ± 0.08). Heifers assigned to BAS had lower (P < 0.01) chute entrance score on d 6, 15, and 45, and chute exit score on d 2 to 45 (P = 0.05) when compared to heifers assigned to CON. Additionally, heifers assigned to BAS tended (P = 0.08) to have lower chute score, from d 1 to 150 than heifers assigned to CON. The application of BAS at weaning improved heifers ADG, likely due to an improvement in temperament, suggesting that BAS application has calming effects in the beef cattle herd.

304 Effects of Supplementing Phix-up® on Productive, Physiological, and Rumen Responses of Feedlot Cattle Consuming a Corn-based Finishing Diet

2021 ◽  
Vol 99 (Supplement_3) ◽  
pp. 162-163
Author(s):  
Eduardo Colombo ◽  
Reinaldo F Cooke ◽  
Kelsey Harvey ◽  
Jacob Wiegand ◽  
Ana Clara Araujo ◽  
...  
Keyword(s):  
Physiological Responses ◽  
Latin Square ◽  
Feedlot Cattle ◽  
Hair Cortisol ◽  
Finishing Cattle ◽  
Rumen Ph ◽  
Hair Samples ◽  
Buffering Agent ◽  
To Receive ◽  
Feeding Systems

Abstract This experiment (d -14 to 118) compared rumen pH, productive, and physiological responses in finishing cattle supplemented or not with a rumen-buffering agent (pHix-up®; Timab, Dinard, France). Angus-influenced yearling cattle (58 heifers and 62 steers) were ranked by sex and body weight (BW) and allocated to 4 groups of 30 animals each (d -14). Groups were housed in 1 of 4 drylot pens equipped with GrowSafe automated feeding systems, and assigned to receive a corn-based diet containing monensin, and with the inclusion of pHix-up® at 0.00% (control) 0.25%, 0.50%, or 0.75% (d 0 to 118). Cattle BW was recorded twice monthly (d -14 to 118), and blood samples were collected on d 0, 28, 56, 84 and 112. Hair samples from the tail-switch were collected on d 0, 56 and 112. Cattle were slaughtered on d 119. Eight rumen-cannulated steers were also assigned to this experiment (d 42 to 98), with 2 steers housed with each group in a replicated 4 × 4 Latin Square design (4 periods of 14 d). Rumen pH was measured on d 7 and 14 of each period at 0800h, 1200h, 1600h and 2000h. No treatment effects were noted (P ≥ 0.13) for cattle BW gain, feed intake, and feed efficiency. Inclusion of pHix-up® linearly increased (P < 0.01) plasma Mg concentrations and tended to linearly decrease (P = 0.09) plasma haptoglobin concentrations. Cattle receiving pHix-up® had greater (P < 0.01) mean plasma cortisol concentrations compared with non-supplemented cattle. Hair cortisol concentration linearly decreased (P < 0.01) as pHix-up® inclusion increased on d 112 (treatment × day interaction; P = 0.02). In rumen-cannulated steers, pHix-up® inclusion linearly increased (P = 0.03) mean rumen pH. Collectively, pHix-up® supplementation improved rumen pH and modulated stress-related physiological responses in finishing cattle, but without improving their productive responses.

Glucose 250, MD Notified: A Case Report.

2020 ◽  
pp. 1-3
Keyword(s):  
Insulin Therapy ◽  
Serum Insulin ◽  
Serum Cortisol ◽  
Primary Diagnosis ◽  
Serum Glucose ◽  
High Serum ◽  
Intravenous Glucose ◽  
Glucose Levels ◽  
Normal Ranges ◽  
Low Rate

Background: Hyperglycemia is common in neonates. Insulin therapy is used to treat hyperglycemia. Threshold for treating hyperglycemia varies among the neonatal practitioners. The renal threshold for glucose is 180 mg/dl, so most practitioners wait on insulin therapy till the serum glucose level reaches 180 mg/dl. We describe a case of a neonatal hyperglycemia of greater than 250 mg/dl that was successfully managed conservatively. Clinical Findings: The neonate, who was depressed at birth, was noted to have high serum glucose levels soon after birth. Serial glucose levels within first six hours of life were persistently above 200 mg/dl. The serum cortisol was normal while serum insulin was low. Infant was provided a low rate of intravenous glucose without giving any insulin. The serum glucose declined to normal levels within 24 hours. Primary diagnosis: Stress-induced transitional hyperglycemia. Interventions: We performed a serial monitoring on serum glucose and provided intravenous dextrose solution at a very low rate. The glucose infusion rate used was only 2.6 mg/kg/min. We were able to bring down the serum glucose to normal ranges conservatively without using any insulin therapy. Outcomes: Infant responded to conservative management and serum glucose was normalized within 24-hours. Practical Recommendations: Stress-induced hyperglycemia soon after birth is transitional and could be managed conservatively without insulin therapy.

scholarly journals 118 Administering a synthetic appeasing pheromone to Bos indicus-influenced beef cattle at weaning and feedlot entry

2019 ◽  
Vol 97 (Supplement_1) ◽  
pp. 52-53
Author(s):  
Alice Brandão ◽  
Reinaldo F Cooke ◽  
Kelsey Schubach ◽  
Thiago Schumaher ◽  
Osvaldo Souza ◽  
...  
Keyword(s):  
Body Weight ◽  
Beef Cattle ◽  
Treatment Effects ◽  
Bos Indicus ◽  
Feedlot Cattle ◽  
Cow Calf ◽  
Calming Effect ◽  
To Receive

Abstract Synthetic appeasing pheromone (SAP) is expected to have a calming effect in cattle experiencing stressful situations, including weaning and feedlot arrival. In Exp. 1, 186 Bos indicus-influenced calves (73 heifers, 133 bulls) were weaned at 211 ± 1 d of age (d 0). Upon weaning, calves were ranked by sex and body weight (BW), and assigned to receive SAP (Nutricorp, Araras, SP, Brazil; n = 94) or water (CON; n = 92). Treatments (5 mL) were topically applied to the forehead of each animal. Calf BW was recorded on d 15 and 45. Calves that received SAP had greater (P < 0.01) average daily again (ADG) from d 0 to 15, and BW on d 15 compared with CON (0.94 vs. 0.73 kg/d and 249 vs. 246 kg; respectively). Calf ADG from d 15 to 45 was similar (P = 0.97) between treatments. Overall ADG and BW on d 45 were also greater in SAP vs. CON (0.36 vs. 0.29 kg/d and 251 vs. 248 kg; respectively). In Exp. 2, 140 Bos indicus-influenced bulls (~27 mo of age) were transported from a cow-calf ranch to a commercial feedlot (d -1), and maintained on a single pasture for 24 h. On d 0, bulls were ranked by BW and assigned to receive SAP (n = 70) or CON (n = 70) as in Exp. 1. Bulls receiving SAP had greater (P = 0.04) ADG from d 0 to 15, but less (P <0.01) ADG from d 15 to 45 compared to CON (1.65 vs. 1.45 kg/d and 1.42 vs. 1.65 kg/d; respectively). No other treatment effects were detected (P ≥ 0.18). Therefore, SAP administration to beef cattle at weaning or feedlot entry had immediate benefits to ADG, which were sustained for 45 d in weaned calves but not in feedlot cattle

scholarly journals 150 Administering an appeasing substance to Bos indicus-influenced beef cattle at weaning and feedlot entry

2019 ◽  
Vol 97 (Supplement_3) ◽  
pp. 149-149
Author(s):  
Allison Millican ◽  
Reinaldo F Cooke ◽  
Alice Brandão ◽  
Thiago Schumaher ◽  
Osvaldo Souza ◽  
...  
Keyword(s):  
Body Weight ◽  
Beef Cattle ◽  
Treatment Effects ◽  
Plasma Concentrations ◽  
Bos Indicus ◽  
Feedlot Cattle ◽  
Cow Calf ◽  
Calming Effect ◽  
To Receive

Abstract Bovine appeasing substance (BAS) is expected to have calming effect in cattle experiencing stressful situations, including weaning and feedlot arrival. In Exp. 1, 186 Bos indicus-influenced calves (73 heifers, 133 bulls) were weaned at 211 ± 1 d of age (d 0). Upon weaning, calves were ranked by sex and body weight (BW), and assigned to receive BAS (Nutricorp, Araras, SP, Brazil; n = 94) or water (CON; n = 92). Treatments (5-mL) were topically applied to the forehead of each animal. Calf BW was recorded and samples of blood and tail-switch hair collected on d 0, 15, and 45. Calves that received BAS had greater (P &lt; 0.01) average daily again (ADG) from d 0 to 15, and BW on d 15 compared with CON. Overall ADG and BW on d 45 were also greater (P &lt; 0.05) in BAS vs. CON. Plasma concentrations of haptoglobin were less (P &lt; 0.01) in BAS vs. CON cattle on d 15, whereas cortisol concentrations in plasma and tail-switch hair did not differ between treatments (P &gt; 0.16). In Exp. 2, 140 B. indicus-influenced bulls (~27 mo of age) were transported from a cow-calf ranch to a commercial feedlot (d -1), and maintained on a single pasture for 24 h. On d 0, bulls were ranked by BW and assigned to receive BAS (n = 70) or CON (n = 70) as in Exp. 1. Bulls receiving BAS had greater (P = 0.04) ADG from d 0 to 15, but less (P &lt; 0.01) ADG from d 15 to 45 compared to CON. No other treatment effects were detected (P &gt; 0.18). Therefore, BAS administration to beef cattle at weaning or feedlot entry had immediate benefits to ADG, which were sustained for 45 d in weaned calves but not in feedlot cattle.

PSX-B-17 Appeasing substance application at weaning enhanced growth and temperament of bos indicus-influenced weaned calves in grazing system

2021 ◽  
Vol 99 (Supplement_3) ◽  
pp. 220-220
Author(s):  
Douglas G Viera ◽  
Juliana Ranches ◽  
Bruno I Cappellozza ◽  
Henrique J Fernandes ◽  
Marcella D’Oliveira ◽  
...  
Keyword(s):  
Body Weight ◽  
Single Dose ◽  
Average Daily Gain ◽  
Bos Indicus ◽  
Synthetic Analogue ◽  
Skin Area ◽  
Grazing System ◽  
Urochloa Brizantha ◽  
To Receive ◽  
Daily Gain

Abstract The objective of this study was to evaluate the effects of a synthetic analogue of the bovine appeasing pheromone (i.e. bovine appeasing substance; BAS) on growth and temperament of weaned calves grazing Capim-Marandú (Urochloa brizantha cv Marandú). At weaning (d 0), 86 calves (47 steers and 39 heifers; Aberdeen Angus ′ Nelore; 8 ± 1 mo) were stratified by body weight (197.9 ± 24.9 kg) and randomly assigned to receive a single dose of BAS (n = 43; SecureCattle; Nutricorp, Araras, SP, Brazil) or saline (CON; n = 43; saline 0.9% NaCl). Treatments (5 ml) were topically applied to the nuchal skin area of each animal on d0. Body weight was collected on d 0, 8, 15, 51 and 100. Chute score (1 to 5; 1 = calm, no movement; 5 = violent and continuous struggling) and chute entrance and exit scores (1 to 3; 1 = slow; 3 = fast) were collected on d 3, 8, 15, 51 and 100. Scores were averaged across 3 trained technicians. Data were analyzed using the MIXED procedure of SAS. Calves assigned to BAS treatment had greater (P &lt; 0.01) average daily gain (ADG) from d 8 to 15 (0.158 and -0.284 kg/d ± 0.07). Calves assigned to BAS treatment tended (P = 0.10) to have lower chute entrance score on d 8 and 51 and had lower (P = 0.02) chute exit score on d 8 than calves assigned to CON treatment. Additionally, calves assigned to BAS treatment tended (P = 0.07) to have lower chute score on d 8 when compared to calves assigned to CON treatment. The application of BAS at weaning improved calf ADG and improved calf temperament as observed by chute score and chute entrance and exit scores, suggesting that BAS application has calming effects.

scholarly journals PSVIII-35 Late-Breaking Abstract: Administration of an appeasing substance at castration improves performance of pre-conditioned beef crossbred steers

2020 ◽  
Vol 98 (Supplement_4) ◽  
pp. 347-348
Author(s):  
Kelsey Schubach ◽  
Bruno I Cappellozza ◽  
Marcos Renato Burim ◽  
André Velasco ◽  
Fernando Sagrado ◽  
...  
Keyword(s):  
Feed Efficiency ◽  
Minimum Distance ◽  
Descriptive Analysis ◽  
Bos Indicus ◽  
Experimental Unit ◽  
Water Restriction ◽  
Improve Performance ◽  
Treatment Groups ◽  
Improved Performance ◽  
To Receive

Abstract Alternatives that alleviate stress-related responses and improve performance of the beef cattle herd are imperative and deserve further investigation. In previous trials, administration of the bovine appeasing substance (BAS) has improved performance of newly-weaned and feedlot received beef animals, as well as reduced the risk of dark, firm, and dry (DFD) cuts in carcass obtained from Bos indicus cattle. Therefore, this study was designed to evaluate the effects of BAS administration at castration on pre-conditioning performance of crossbred beef animals. On day 0, 390 crossbred Angus × Nellore animals were ranked by initial shrunk BW (255 ± 21.1 kg) and assigned to receive or not (CON) 5 mL/head of BAS (SecureCattle; Nutricorp, Araras, SP, Brazil) immediately before castration. From d 0 to 30, animals within treatments were maintained in 2 feedot pens with a minimum distance (300 m) to avoid contact between treatment groups and received a grass hay-based diet (70:30 roughage:concentrate ratio) ad libitum. On day 30, animals were individually weighed following 16 hours of feed and water restriction. Hence, a descriptive analysis was performed to evaluate pen dry matter intake (DMI) and feed efficiency (FE). Animal was considered the experimental unit and all data were analyzed using the PROC MIXED procedure of SAS (version 9.4; SAS Inst. Inc., Cary, NC). Bovine appeasing substance administration at castration improved ADG and BW change (P &lt; 0.0001) compared with CON cohorts (0.983 vs. 1.155 kg/d and 29.5 vs. 34.6 kg for ADG and BW change, respectively). Total DMI was similar among treatments when reported as kg/d (6.70 vs. 6.75 kg) or % of BW (2.48 vs. 2.48%), whereas FE was dramatically improved in BAS-administered animals (146 vs. 172 g/kg for CON and BAS, respectively). In summary, BAS administration improved performance of crossbred beef animals for 30 days post-castration.

scholarly journals 268 Administering an appeasing substance to optimize welfare and performance of receiving cattle

2020 ◽  
Vol 98 (Supplement_4) ◽  
pp. 193-193
Author(s):  
Eduardo Colombo ◽  
Reinaldo F Cooke ◽  
Alice Brandão ◽  
Jacob Wiegand ◽  
Kelsey Schubach ◽  
...  
Keyword(s):  
Feed Intake ◽  
Feed Efficiency ◽  
Treatment Effects ◽  
Average Daily Gain ◽  
Plasma Concentrations ◽  
Feedlot Cattle ◽  
Skin Area ◽  
And Performance ◽  
Antimicrobial Treatments ◽  
Daily Gain

Abstract This experiment evaluated the impacts of bovine appeasing substance (BAS) administration on performance, health, and physiological responses of feedlot cattle during a 45-d receiving period. A total of 342 recently-weaned Angus-influenced steers, originating from 16 cow-calf operations, were obtained from an auction yard on d -1 and road-transported (12 h) to the feedlot. Upon arrival on d 0, body weight (BW) was recorded and steers were ranked by BW and source and assigned to receive BAS (Nutricorp, Araras, SP, Brazil; n = 171) or placebo (diethylene glycol monoethyl ether; CON; n = 171). Treatments (5 mL) were topically applied to the nuchal skin area of each animal. Within treatment, calves were allocated to 1 of 24 drylot pens (12 pens/treatment) and received a free choice total-mixed ration from d 1 to 45. Calves were assessed for bovine respiratory disease (BRD) signs and feed intake was recorded from each pen daily. Steer BW was again recorded on d 1, 7, 17, 31, and 45, whereas blood samples were collected from 5 steers/pen concurrently with each BW assessment. Average daily gain was greater (P = 0.05) in BAS vs. CON calves, although final BW did not differ (P = 0.36) between treatments. No treatment effects were detected for feed intake (P = 0.95), resulting in greater (P = 0.05) feed efficiency in BAS vs. CON steers. No treatment effects were detected (P ≥ 0.37) for plasma concentrations of haptoglobin, whereas plasma cortisol concentrations were greater (P = 0.05) in CON vs. BAS steers on d 7 (treatment × day; P = 0.07). Incidence of BRD was greater (P ≤ 0.05) in BAS vs. CON on d 6 to 10 and d 18 to 21 (treatment × day; P &lt; 0.01), although overall BRD incidence did not differ (P = 0.24) between treatments. The number of antimicrobial treatments required per steer diagnosed with BRD symptoms to recover from sickness was greater (P = 0.04) in CON vs. BAS calves. No treatment differences were detected (P ≥ 0.41) for mortality incidence, or proportion of steers removed from the experiment due to extreme sickness. Results from this experiment indicate BAS administration upon feedlot entry improved average daily gain by enhancing feed efficiency. Administration of BAS facilitated earlier detection of BRD and reduced the need for antimicrobial treatments. Collectively, these results suggest BAS administration as a promising strategy to benefit performance and immunocompetence of feedlot receiving cattle.

Effects of cortisol and progesterone on insulin binding and lipogenesis in adipocytes from normal and diabetic rats

1985 ◽  
Vol 106 (2) ◽  
pp. 225-231 ◽  
Author(s):  
A.-M. Mendes ◽  
R. J. Madon ◽  
D. J. Flint
Keyword(s):  
Body Weight ◽  
Adipose Tissue ◽  
Insulin Sensitivity ◽  
Insulin Receptor ◽  
Body Weight Gain ◽  
Serum Insulin ◽  
Insulin Binding ◽  
Serum Glucose ◽  
Diabetic Rats ◽  
Receptor Concentration

ABSTRACT Cortisol implants in normal and diabetic rats reduced body weight, adiposity, insulin receptor concentration and both basal and insulin-stimulated rates of lipogenesis in isolated adipocytes, whilst insulin sensitivity was unchanged. In normal but not diabetic rats these changes were accompanied by increased serum glucose and insulin concentrations. In contrast, progesterone implants in normal and diabetic rats increased body weight gain, adiposity, insulin receptor concentration and both basal and insulin-stimulated rates of lipogenesis in adipose tissue, again without affecting insulin sensitivity. Progesterone did not affect serum insulin concentrations in normal or diabetic rats but accelerated the decline in serum glucose concentrations which occurred during an overnight fast in diabetic rats. The results suggest that (1) cortisol inhibits lipogenesis in adipose tissue without affecting insulin sensitivity, (2) cortisol reduces insulin binding in adipose tissue without a requirement for hyperinsulinaemia, which might itself indirectly lead to down-regulation of the insulin receptor, and (3) in diabetic rats progesterone stimulates lipogenesis in adipose tissue without any increase in food intake or serum insulin concentrations suggesting that progesterone may have a direct anabolic role in adipose tissue. J. Endocr. (1985) 106, 225–231

Solumedrol Treatment for Severe Sepsis in Humans with a Blunted Adrenocorticotropic Hormone-Cortisol Response: A Prospective Randomized Double-Blind Placebo-Controlled Pilot Clinical Trial

2021 ◽  
pp. 088506662110388
Author(s):  
Divya Birudaraju ◽  
Sajad Hamal ◽  
John A. Tayek
Keyword(s):  
Blood Pressure ◽  
Clinical Trial ◽  
Adrenocorticotropic Hormone ◽  
Serum Cortisol ◽  
High Dose ◽  
Cortisol Response ◽  
Acth Stimulation ◽  
Double Blind ◽  
Significant Difference ◽  
To Receive

Purpose To test the benefits of Solumedrol treatment in sepsis patients with a blunted adrenocorticotropic hormone (ACTH)-cortisol response (delta <13 µg/dL) with regard to the number of days on ventilator, days on intravenous blood pressure support, length of time in an intensive care unit (ICU), 14-day mortality, and 28-day mortality. The trial was prospective, randomized, and double-blind. As part of a larger sepsis trial, 54 patients with sepsis had an intravenous ACTH stimulation test using 250 µg of ACTH, and serum cortisol was measured at times 0, 30, and 60 min. Eleven patients failed to increase their cortisol concentration above 19.9 µg/dL and were excluded from the clinical trial as they were considered to have adrenal insufficiency. The remaining 43 patients had a baseline cortisol of 32 ± 1 µg/dL increased to 38 ± 3 µg/dL at 30 min and 40 ± 3 at 60 min. All cortisol responses were <12.9 µg/dL between time 0 and time 60, which is defined as a blunted cortisol response to intravenous ACTH administration. Twenty-one were randomized to receive 20 mg of intravenous Solumedrol and 22 were randomized to receive a matching placebo every 8 h for 7-days. There was no significant difference between the two randomized groups. Data analysis was carried out bya two-tailed test and P < .05 as significant. Results Results: The mean age was 51 ± 2 (mean ± SEM) with 61% female. Groups were well matched with regard to APACHE III score in Solumedrol versus placebo (59 ± 6 vs 59 ± 6), white blood cell count (18.8 ± 2.2 vs 18.6 ± 2.6), and incidence of bacteremia (29 vs 39%). The 28-day mortality rate was reduced in the Solumedrol treated arm (43 ± 11 vs 73 ± 10%; P < .05). There was no change in days in ICU, days on blood pressure agents, or days on ventilator. Seven days of high-dose intravenous Solumedrol treatment (20 mg every 8 h) in patients with a blunted cortisol response to ACTH was associated with an improved 28-day survival. This small study suggests that an inability to increase endogenous cortisol production in patients with sepsis who are then provided steroid treatment could improve survival.

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