What are the risks for a patient who received a total of 187.5mg of Solumedrol (methylprednisolone) intravenously (IV), with the last dose administered 15 hours ago?

From the Guidelines

The patient who received a total of 187.5mg of Solumedrol (methylprednisolone) IV, with the last dose administered 15 hours ago, is at low risk for significant adverse effects from this relatively modest, short-term steroid exposure. The most common immediate risks include mild hyperglycemia, insomnia, increased appetite, and mood changes, which typically resolve quickly as the medication clears the system. With methylprednisolone's half-life of 12-36 hours, most of the drug is still active in the body, but levels are declining. According to the 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus 1, the risks associated with glucocorticoids are substantially increased at continuous doses above 7.5 mg/day prednisone equivalent, but this patient's exposure is short-term and not expected to reach harmful levels. No specific intervention is needed at this time beyond routine monitoring. If the patient has diabetes, blood glucose monitoring would be prudent for the next 24-48 hours. The patient should be informed that any side effects experienced should resolve within 1-3 days as the medication is eliminated.

Some key points to consider in this patient's care include:

• Monitoring for signs of hyperglycemia, particularly if the patient has a history of diabetes
• Assessing for any changes in mental status or mood
• Providing guidance on potential side effects and their expected duration
• Considering the patient's overall clinical condition and adjusting care as needed to minimize the risk of adverse effects. Given the information from 1, high-dose intravenous methylprednisolone is often used in acute, organ-threatening disease, but this patient's dose is not in that range, and the primary concern is monitoring for and managing any short-term side effects.

From the FDA Drug Label

Corticosteroids, including methylprednisolone, suppress the immune system and increase the risk of infection with any pathogen, including viral, bacterial, fungal, protozoan, or helminthic pathogens Corticosteroids can: • Reduce resistance to new infections • Exacerbate existing infections • Increase the risk of disseminated infections • Increase the risk of reactivation or exacerbation of latent infections • Mask some signs of infection The rate of infectious complications increases with increasing corticosteroid dosages.

The patient's risks include:

• Increased risk of infection: The patient is at a higher risk of developing new infections or exacerbating existing ones due to the immunosuppressive effects of methylprednisolone.
• Reactivation of latent infections: The patient may be at risk of reactivating latent infections such as tuberculosis, hepatitis B, or varicella zoster.
• Masked signs of infection: The patient's symptoms of infection may be masked by the corticosteroid, making it more difficult to diagnose and treat infections promptly. It is essential to monitor the patient closely for signs of infection and adjust the treatment plan as needed 2.

From the Research

Risks Associated with Solumedrol Administration

The patient received a total of 187.5mg of Solumedrol (methylprednisolone) intravenously, with the last dose administered 15 hours ago. The risks associated with this administration include:

• Hyperglycemia: Methylprednisolone can cause significant increases in blood glucose levels, even in non-diabetic patients 3, 4, 5, 6.
• Steroid-induced hyperglycemia: This condition can lead to the development of type 2 diabetes, as seen in a case report where a patient was diagnosed with type 2 diabetes after receiving methylprednisolone 7.
• Increased risk of hypoglycemic events: Although rare, hypoglycemic events can occur, especially when insulin therapy is initiated to manage hyperglycemia 4.
• Other side effects: Methylprednisolone can cause other side effects, such as systolic and/or diastolic blood pressure elevation, ketosis, silent myocardial ischemia, and disorientation 5.

Monitoring and Management

To mitigate these risks, it is essential to:

• Monitor blood glucose levels closely, especially in the initial phase after methylprednisolone administration 3, 4, 5.
• Initiate insulin therapy, if necessary, to manage hyperglycemia 7, 4.
• Adjust insulin dosing and type, as needed, to achieve target glucose levels 7.
• Be aware of the potential for hypoglycemic events and take preventive measures 4.
• Monitor for other side effects, such as changes in blood pressure and ketosis 5.