A review of associated controversies surrounding glucocorticoid use in veterinary emergency and critical care

J Vet Emerg Crit Care (San Antonio). 2017 May;27(3):267-277. doi: 10.1111/vec.12603. Epub 2017 Apr 27.


Objective: To review the literature in human and veterinary medicine regarding the indications for, efficacy of, and controversies surrounding glucocorticoid (GC) administration in the emergency and critical care (ECC) setting, and to provide an overview of the most commonly used synthetic GC formulations.

Medications: Synthetic GCs vary in GC and mineralocorticoid potency, hypothalamic pituitary axis suppression, duration of action, route of administration, and clinical indication for use. Some of the GC compounds commonly used in human and veterinary ECC include hydrocortisone, prednisone, methylprednisolone, and dexamethasone.

Indications for use: GCs are used in human and veterinary ECC for a variety of disorders including anaphylaxis, acute lung injury/acute respiratory distress syndrome, septic shock, and spinal cord injury. Evidence for morbidity or mortality benefit with administration of GC within these populations exists; however, data are sparse and often conflicting.

Adverse effects and contraindications: Routine use of GC in some conditions such as trauma, hemorrhagic shock, and traumatic brain injury is likely contraindicated. GC use has been associated with hyperglycemia, pneumonia, urinary tract infection, gastrointestinal ulceration, or increased mortality in some populations.

Keywords: acute lung injury; canine; feline; septic shock; steroid; traumatic brain injury.

Publication types

  • Review

MeSH terms

  • Animals
  • Critical Care
  • Dexamethasone / adverse effects
  • Dexamethasone / therapeutic use
  • Evidence-Based Medicine
  • Glucocorticoids / adverse effects
  • Glucocorticoids / therapeutic use*
  • Hydrocortisone / adverse effects
  • Hydrocortisone / therapeutic use
  • Respiratory Distress Syndrome / drug therapy
  • Respiratory Distress Syndrome / veterinary
  • Shock, Septic / drug therapy
  • Shock, Septic / veterinary
  • Spinal Cord Injuries / drug therapy
  • Spinal Cord Injuries / veterinary
  • Veterinary Medicine


  • Glucocorticoids
  • Dexamethasone
  • Hydrocortisone