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A 48-year-old male with a history of asthma treated with int…

A 48-year-old male with a history of asthma treated with intermittent steroids, and a history of kidney stones, is admitted to the ICU with urosepsis. He is intubated, started on antibiotics, and fluid resuscitated with 30 mL/kg of normal saline. Despite this therapy he becomes increasingly hypotensive requiring escalating vasopressor doses. An ACTH stimulation test is performed revealing a baseline cortisol of 10 µg/dL and a 30-minute peak of 16 µg/dL. Which of the following interventions is most appropriate given the ACTH test results?

A 65-year-old female is admitted to the ICU after being foun…

A 65-year-old female is admitted to the ICU after being found down at home. Her only medical history is a remote history of Grave’s disease and thyroid ablation. Vital signs are T 89°F, HR 50 bpm, BP 105/61 mm Hg. On physical examination she obtunded, and brittle hair, macroglossia, and periorbital edema are noted. An ABG shows pH 7.30, PaCO2 55, PaO2 65. She is intubated for airway protection ventilatory support. Urine, sputum, and blood cultures are sent, and she is treated with broad spectrum antibiotics. Thyroid function tests are sent and she is started on IV levothyroxine.  Which of the following additional therapies is most appropriate at this time?