Moderator ventana Posted March 11, 2011 Moderator Share Posted March 11, 2011 would he be at risk for addison with such huge elevations of triamcinolone? it is not that he has no steroid on board, but in fact far to much, and would the slow metabolize due to reduced hepatic clearence in effect provide a slow taper back to normal? this is one of the all time great cases!! thank you so much for sharing - and for RC's input! ( I know have to go dig out a text and review this stuff as it all is a little confusing!) Link to comment Share on other sites More sharing options...
rcdavis Posted March 11, 2011 Share Posted March 11, 2011 Yes, thank you. I know I have at least one patient on Norvir, and will reserve steroids for her for respiratory failure based on this case. or brad, if you DO give steroids, I would, based on this case (also review the case report that SM referenced), give much less((1/3-1/2 dose) than the usual dosages (say only 60 mg of solumedrol IV) and then monitor carefully. Where you might see them is down the road when they have been given full adult dosages by ED idiots like me, and then 12-14 week later, are beginning to show signs of ACI due to such a long supression of the HPA axis... I still think serotonin syndrome was a great pull one of the corner dx... oh well. also, is interesting to review symptoms of ACI and Cushings.. very very similar... and not all ACIs have the typical electrolyte imbalances we usually use to think of the dx. v/r rc Link to comment Share on other sites More sharing options...
bradtPA Posted March 12, 2011 Share Posted March 12, 2011 I reviewed some of the other cases, and it can even be caused by inhaled steroids such as fluticasone. This easily could be a disaster in patients with HIV and reactive airway disease..... http://jia.sagepub.com/content/8/2/113.short Link to comment Share on other sites More sharing options...
SocialMedicine Posted March 12, 2011 Author Share Posted March 12, 2011 I was aware of oral and even intranasal steroids resulting in cushing .... these are medicines that are given over periods of time and may even be used in greater than prescribed amounts by patients. It struck me as odd that a single epidural could have that result. I discussed this case with a nurse practitioner I work with ... she had a similar case a few years ago. He had a difficult course and started working with an endocrinologist once cushings was suspected. As the cushing syndrome started improving he went into adrenal crisis following what seemed to be a community aquired PNA and was hospitalised for an extended period. Link to comment Share on other sites More sharing options...
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