What baseline tests are recommended before prescribing a short course of weight-appropriate steroids (corticosteroids)?

Baseline Testing Before Prescribing Short Course of Weight-Appropriate Steroids

No specific baseline laboratory tests are routinely required before prescribing a short course of weight-appropriate corticosteroids in most patients. However, certain evaluations should be considered based on patient-specific factors and comorbidities.

General Approach to Baseline Testing

Essential Considerations

• Blood glucose: Consider checking baseline glucose in patients with diabetes or risk factors for diabetes, as corticosteroids can cause hyperglycemia 1
• Blood pressure: Measure before initiating therapy as corticosteroids may cause sodium retention and hypertension 2
• Medication review: Check for potential drug interactions, especially with medications that may enhance or reduce steroid effects

Patient-Specific Testing Based on Risk Factors

Patients with Diabetes or at Risk for Diabetes

• Baseline blood glucose measurement
• Consider HbA1c if not recently checked
• Plan for glucose monitoring during treatment 1

Patients with Cardiovascular Disease

• Blood pressure measurement
• Consider electrolytes (sodium, potassium) if on diuretics or with heart failure 2

Patients with History of Liver Disease

• Consider baseline liver function tests (ALT, AST) 1

Patients with Suspected Adrenal Insufficiency

• Morning cortisol level if there is concern about HPA axis suppression from previous steroid use 3

Patients with Renal Disease

• Renal function tests (creatinine, BUN) may be appropriate 2

Special Considerations

Medication Discontinuation Before Testing

For certain diagnostic procedures (such as oral food challenge testing), steroids may need to be discontinued:

• Oral/intramuscular/intravenous steroids: 3 days to 2 weeks prior 1

Pregnancy Considerations

• Document pregnancy status in women of childbearing age before prescribing 2

Pediatric Considerations

• Consider baseline height and weight measurements to monitor growth velocity in children requiring repeated courses 2

Common Pitfalls to Avoid

1. Overlooking diabetes risk: Steroids can significantly worsen glycemic control in patients with known or undiagnosed diabetes

2. Missing adrenal insufficiency: Patients on chronic steroids or who have recently discontinued steroids may have adrenal suppression and require different management

3. Failing to check for contraindications: Certain conditions like systemic fungal infections may be worsened by steroid therapy

4. Not considering drug interactions: Some medications may enhance or diminish steroid effects

Practical Approach for Short-Course Therapy

For most healthy patients requiring a short course (typically <2 weeks) of weight-appropriate corticosteroids:

• Complete medical history focusing on diabetes, hypertension, psychiatric disorders, and previous steroid use
• Blood pressure measurement
• Consider point-of-care glucose testing if diabetes risk factors present

For longer courses (>2 weeks) or higher doses, more comprehensive baseline testing may be warranted, including:

• Complete blood count
• Comprehensive metabolic panel
• Lipid profile
• Bone density assessment if prolonged use anticipated

Remember that the risk of significant adverse effects increases with higher doses and longer duration of treatment 4, so the minimum effective dose and duration should always be used.