Steroid toxicity in CIM is caused by what?

• A. Excessive steroids in the body
• B. Low steroid levels
• C. Steroid taken only during illness
• D. Steroid toxicity is not related

Answer: (A)

Steroid toxicity in CIM comes from sustained high levels of glucocorticoids in the body. When exposure is prolonged or the dose is large, steroids drive muscle breakdown and inhibit muscle protein synthesis, especially in proximal muscles, leading to the characteristic weakness seen in critically ill patients. The mechanism involves increased proteolysis via pathways like the ubiquitin–proteasome system and suppression of anabolic processes, which together cause a catabolic state in skeletal muscle. Therefore, excessive steroids, rather than low levels or brief use, are what contribute to this toxicity. Taking steroids only during illness can still pose a risk if the dose and duration are high enough, but the core issue remains the amount of steroid in the body.