Discussion of interesting or befuddling cases related to pulmonary and critical care medicine.
Thursday, May 12, 2005
Choice of IV steroids
People at HF give decadron for COPD and asthma exacerbations. I am used to solumedrol. Most people use solumedrol - is there an advantage of one over the other for the treatment of copd/ashtma?
I don't think there's an advantage to one steroid over another. Most studies I've looked at use solumedrol; but I think that there has recently been a national shortage in solumedrol, and people here have needed to use decadron some. Also, maybe with all the emerging literature regarding adrenal insufficiency, people don't want to use Solumedrol because they won't be able to do a cort stim if the patient becomes hypotensive! (Actually, I doubt that has any relevence...)
The pulmonary guys down here also use solumedrol but a lot of the primary care give decadron (IV and PO as outPt) for AECB. I agree with JCH: most of the studies are done with solumedrol but there shouldn't be a big difference.
Just wanted to say this is a great blog. Keep it up guys. Also, if you've just started blogging you might want to meet the great bunch of med professionals who blog. It's becoming a very big community.
If you're interested in letting your cases reach a wider medical audience, why not start submiting posts to the Medblog version of a Carnival. It's called Grand Rounds. The guy who originated it is Nick Genes of Blogborygmi. Medlogs rotate to host it very week. The archive of Grand Rounds is maintained at an Undisclosed Location (heh), a medblog written by a fourth year.
If at some point in the future you want to host, just email Nick.
The other issue is that dex does not have much mineralocorticoid effect. By giving this in sick patients, it may not give all of the "bang" you get with a more complete steroid (hydrocortisone or methyprednisolone). Most review articles imply that by giving saline and paying attention to electrolytes, aldosterone activity in the short-run is really insignficant. But, as JCH mentioned, it may be problematic in relative adrenal insuff if you forget to change.
Ok, it has been 10 years since I have read Guyton, but remind me again what mineralcorticoid activity has to do with beta agonism and anti inflammatory activity which is modulated by the glucocorticoid activity not mineralcorticoid. So why would you want more mineralcorticoid activity when what your goal is cortisol action?
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I don't think there's an advantage to one steroid over another. Most studies I've looked at use solumedrol; but I think that there has recently been a national shortage in solumedrol, and people here have needed to use decadron some. Also, maybe with all the emerging literature regarding adrenal insufficiency, people don't want to use Solumedrol because they won't be able to do a cort stim if the patient becomes hypotensive! (Actually, I doubt that has any relevence...)
The pulmonary guys down here also use solumedrol but a lot of the primary care give decadron (IV and PO as outPt) for AECB. I agree with JCH: most of the studies are done with solumedrol but there shouldn't be a big difference.
Just wanted to say this is a great blog. Keep it up guys. Also, if you've just started blogging you might want to meet the great bunch of med professionals who blog. It's becoming a very big community.
If you're interested in letting your cases reach a wider medical audience, why not start submiting posts to the Medblog version of a Carnival. It's called Grand Rounds. The guy who originated it is Nick Genes of Blogborygmi. Medlogs rotate to host it very week. The archive of Grand Rounds is maintained at an Undisclosed Location (heh), a medblog written by a fourth year.
If at some point in the future you want to host, just email Nick.
The other issue is that dex does not have much mineralocorticoid effect. By giving this in sick patients, it may not give all of the "bang" you get with a more complete steroid (hydrocortisone or methyprednisolone). Most review articles imply that by giving saline and paying attention to electrolytes, aldosterone activity in the short-run is really insignficant. But, as JCH mentioned, it may be problematic in relative adrenal insuff if you forget to change.
Ok, it has been 10 years since I have read Guyton, but remind me again what mineralcorticoid activity has to do with beta agonism and anti inflammatory activity which is modulated by the glucocorticoid activity not mineralcorticoid. So why would you want more mineralcorticoid activity when what your goal is cortisol action?
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